0000899243-17-026997.txt : 20171120 0000899243-17-026997.hdr.sgml : 20171120 20171120172827 ACCESSION NUMBER: 0000899243-17-026997 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171120 FILED AS OF DATE: 20171120 DATE AS OF CHANGE: 20171120 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ross Michael Jay CENTRAL INDEX KEY: 0001254452 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38295 FILM NUMBER: 171214822 MAIL ADDRESS: STREET 1: C/O SV HEALTH INVESTORS, LLC STREET 2: ONE BOSTON PLC, 201 WASHINGTON ST. #3900 CITY: BOSTON STATE: MA ZIP: 02108 FORMER NAME: FORMER CONFORMED NAME: ROSS MICHAEL JAY DATE OF NAME CHANGE: 20030715 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Arsanis, Inc. CENTRAL INDEX KEY: 0001501697 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 273181608 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 890 WINTER STREET, SUITE 230 CITY: WALTHAM STATE: MA ZIP: 02451 BUSINESS PHONE: 781-819-5704 MAIL ADDRESS: STREET 1: 890 WINTER STREET, SUITE 230 CITY: WALTHAM STATE: MA ZIP: 02451 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-11-20 0 0001501697 Arsanis, Inc. ASNS 0001254452 Ross Michael Jay C/O SV HEALTH INVESTORS ONE BOSTON PLACE SUITE 3900, 201 WASHINGTON STREET BOSTON MA 02108 1 0 1 0 Common Stock 2017-11-20 4 C 0 19128 A 19128 I See Footnote Common Stock 2017-11-20 4 C 0 404 A 19532 I See Footnote Common Stock 2017-11-20 4 C 0 247010 A 266542 I See Footnote Common Stock 2017-11-20 4 C 0 5219 A 271761 I See Footnote Common Stock 2017-11-20 4 C 0 322102 A 593863 I See Footnote Common Stock 2017-11-20 4 C 0 6806 A 600669 I See Footnote Common Stock 2017-11-20 4 C 0 111955 A 712624 I See Footnote Common Stock 2017-11-20 4 C 0 2365 A 714989 I See Footnote Common Stock 2017-11-20 4 C 0 202915 A 917904 I See Footnote Common Stock 2017-11-20 4 C 0 4288 A 922192 I See Footnote Common Stock 2017-11-20 4 C 0 431980 A 1354172 I See Footnote Common Stock 2017-11-20 4 C 0 14789 A 1368961 I See Footnote Common Stock 2017-11-20 4 P 0 483448 10.00 A 1852409 I See Footnote Common Stock 2017-11-20 4 P 0 16552 10.00 A 1868961 I See Footnote Series A-1 Convertible Preferred Stock 2017-11-20 4 C 0 65287 0.00 D Common Stock 19128 0 I See Footnote Series A-1 Convertible Preferred Stock 2017-11-20 4 C 0 1380 0.00 D Common Stock 404 0 I See Footnote Series A-2 Convertible Preferred Stock 2017-11-20 4 C 0 690259 0.00 D Common Stock 247010 0 I See Footnote Series A-2 Convertible Preferred Stock 2017-11-20 4 C 0 14587 0.00 D Common Stock 5219 0 I See Footnote Series B Convertible Preferred Stock 2017-11-20 4 C 0 721402 0.00 D Common Stock 322102 0 I See Footnote Series B Convertible Preferred Stock 2017-11-20 4 C 0 15246 0.00 D Common Stock 6806 0 I See Footnote Series C Convertible Preferred Stock 2017-11-20 4 C 0 224665 0.00 D Common Stock 111955 0 I See Footnote Series C Convertible Preferred Stock 2017-11-20 4 C 0 4747 0.00 D Common Stock 2365 0 I See Footnote Series D Convertible Preferred Stock 2017-11-20 4 C 0 692552 0.00 D Common Stock 202915 0 I See Footnote Series D Convertible Preferred Stock 2017-11-20 4 C 0 14635 0.00 D Common Stock 4288 0 I See Footnote Series D Convertible Preferred Stock 2017-11-20 4 C 0 1474348 0.00 D Common Stock 431980 0 I See Footnote Series D Convertible Preferred Stock 2017-11-20 4 C 0 50477 0.00 D Common Stock 14789 0 I See Footnote The Series A-1 Convertible Preferred Stock converted into Common Stock on a 0.29300-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series A-1 Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date. The Series A-2 Convertible Preferred Stock converted into Common Stock on a 0.35785-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series A-2 Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date. The Series B Convertible Preferred Stock converted into Common Stock on a 0.44650-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series B Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date. The Series C Convertible Preferred Stock converted into Common Stock on a 0.49832-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series C Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date. The Series D Convertible Preferred Stock converted into Common Stock on a 0.29300-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series D Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date. These shares are owned directly by SV Life Sciences Fund V, L.P. ("SVLS V LP"). SV Life Sciences Fund V (GP), LP ("SVLS V GP") is the general partner of SVLS V LP. The general partner of SVLS V GP is SVLSF V, LLC. The reporting person, a member of the investment committee of SVLSF V, LLC, may be deemed to share voting, dispositive and investment power over the shares held of record by SVLS V LP. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. These shares are owned directly by SV Life Sciences Fund V Strategic Partners, L.P. ("SVLS V SPP"). SVLS V GP is the general partner of SVLS V SPP. The general partner of SVLS V GP is SVLSF V, LLC. The reporting person, a member of the investment committee of SVLSF V, LLC, may be deemed to share voting, dispositive and investment power over the shares held of record by SVLS V LP. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. These shares are owned directly by SV Life Sciences Fund VI, L.P. ("SVLS VI LP"). SV Life Sciences Fund VI (GP), LP ("SVLS VI GP") is the general partner of SVLS VI LP. The general partner of SVLS VI GP is SVLSF VI, LLC. The reporting person, a member of the investment committee of SVLSF VI, LLC, may be deemed to share voting, dispositive and investment power over the shares held of record by SVLS V LP. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. These shares are owned directly by SV Life Sciences Fund VI Strategic Partners, L.P. ("SVLS VI SPP"). SVLS VI GP is the general partner of SVLS VI SPP. The general partner of SVLS VI GP is SVLSF VI, LLC. The reporting person, a member of the investment committee of SVLSF VI, LLC, may be deemed to share voting, dispositive and investment power over the shares held of record by SVLS V LP. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. /s/ Mike Gray, attorney-in-fact 2017-11-20