0001209191-16-110187.txt : 20160323 0001209191-16-110187.hdr.sgml : 20160323 20160323141504 ACCESSION NUMBER: 0001209191-16-110187 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160323 FILED AS OF DATE: 20160323 DATE AS OF CHANGE: 20160323 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Senseonics Holdings, Inc. CENTRAL INDEX KEY: 0001616543 STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL INSTRUMENTS FOR MEASUREMENT, DISPLAY, AND CONTROL [3823] IRS NUMBER: 471210911 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 20451 SENECA MEADOWS PARKWAY CITY: GERMANTOWN STATE: MD ZIP: 20876 BUSINESS PHONE: (301) 515-7260 MAIL ADDRESS: STREET 1: 20451 SENECA MEADOWS PARKWAY CITY: GERMANTOWN STATE: MD ZIP: 20876 FORMER COMPANY: FORMER CONFORMED NAME: ASN Technologies, Inc. DATE OF NAME CHANGE: 20140813 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ROEDER DOUGLAS A CENTRAL INDEX KEY: 0001270735 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37717 FILM NUMBER: 161523581 MAIL ADDRESS: STREET 1: 3000 DAND HILL RD, BLDG 1, STE 135 STREET 2: C/O DELPHI VENTURES CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PAKIANATHAN DEEPIKA CENTRAL INDEX KEY: 0001270734 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37717 FILM NUMBER: 161523582 MAIL ADDRESS: STREET 1: 3000 SAND HILL RD, BLDG 1, STE 135 STREET 2: C/O DELPHI VENTURES CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DOUGLASS DAVID L CENTRAL INDEX KEY: 0001271389 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37717 FILM NUMBER: 161523583 MAIL ADDRESS: STREET 1: 3000 SAND HILL RD STREET 2: BUILDING 1, SUITE 135 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DELPHI VENTURES VIII LP CENTRAL INDEX KEY: 0001436285 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37717 FILM NUMBER: 161523584 BUSINESS ADDRESS: STREET 1: 3000 SAND HILL ROAD STREET 2: BUILDING 1, SUITE 135 CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-854-9657 MAIL ADDRESS: STREET 1: 3000 SAND HILL ROAD STREET 2: BUILDING 1, SUITE 135 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BOCHNOWSKI JAMES J CENTRAL INDEX KEY: 0001255743 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37717 FILM NUMBER: 161523586 MAIL ADDRESS: STREET 1: C/O DELPHI VENTURES STREET 2: 3000 SAND HILL ROAD STE 135 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Delphi BioInvestments VIII LP CENTRAL INDEX KEY: 0001451526 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37717 FILM NUMBER: 161523585 BUSINESS ADDRESS: STREET 1: 300 Sand Hill Rd STREET 2: Building 1 Suite 135 CITY: Menlo Park STATE: CA ZIP: 94025 BUSINESS PHONE: 650 854 9650 MAIL ADDRESS: STREET 1: 300 Sand Hill rd STREET 2: Building 1 Suite 135 CITY: Menlo pARK STATE: ca ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Delphi Management Partners VIII, L.L.C. CENTRAL INDEX KEY: 0001457494 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37717 FILM NUMBER: 161523587 BUSINESS ADDRESS: STREET 1: 3000 SAND HILL ROAD, 1-135 CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-854-9650 MAIL ADDRESS: STREET 1: 3000 SAND HILL ROAD, 1-135 CITY: MENLO PARK STATE: CA ZIP: 94025 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-03-23 0 0001616543 Senseonics Holdings, Inc. SENS 0001457494 Delphi Management Partners VIII, L.L.C. C/O DELPHI VENTURES 160 BOVET ROAD, SUITE 408 SAN MATEO CA 94402 0 0 1 0 0001255743 BOCHNOWSKI JAMES J C/O DELPHI VENTURES 160 BOVET ROAD, SUITE 408 SAN MATEO CA 94402 0 0 1 0 0001451526 Delphi BioInvestments VIII LP 160 BOVET ROAD, SUITE 408 SAN MATEO CA 94402 0 0 1 0 0001436285 DELPHI VENTURES VIII LP 160 BOVET ROAD, SUITE 408 SAN MATEO CA 94402 0 0 1 0 0001271389 DOUGLASS DAVID L C/O DELPHI VENTURES 160 BOVET ROAD, SUITE 408 SAN MATEO CA 94402 0 0 1 0 0001270734 PAKIANATHAN DEEPIKA C/O DELPHI VENTURES 160 BOVET ROAD, SUITE 408 SAN MATEO CA 94402 0 0 1 0 0001270735 ROEDER DOUGLAS A C/O DELPHI VENTURES 160 BOVET ROAD, SUITE 408 SAN MATEO CA 94402 1 0 1 0 Common Stock 2016-03-23 4 P 0 1216195 2.85 A 11237221 I Delphi Ventures VIII, L.P. Common Stock 2016-03-23 4 P 0 11875 2.85 A 109725 I Delphi BioInvestments VIII, L.P. The reported securities are directly owned by Delphi Ventures VIII, L.P. ("DV VIII"). Delphi Management Partners VIII, L.L.C. ("DMP VIII") is the general partner of DV VIII and may be deemed to have sole voting and dispositive power over the securities held by DV VIII. Douglas A. Roeder, James J. Bochnowski, David L. Douglass and Deepika R. Pakianathan, Ph.D. are the managing members of DMP VIII and may be deemed to share voting and dispositive power over the securities held by DV VIII. Such persons and entities disclaim beneficial ownership of the securities held by DV VIII, except to the extent of any pecuniary interest therein. The reported securities are directly owned by Delphi BioInvestments VIII, L.P. ("DBI VIII"). DMP VIII is the general partner of DBI VIII and may be deemed to have sole voting and dispositive power over the securities held by DBI VIII. Douglas A. Roeder, James J. Bochnowski, David L. Douglass and Deepika R. Pakianathan, Ph.D. are the managing members of DMP VIII and may be deemed to share voting and dispositive power over the securities held by DBI VIII. Such persons and entities disclaim beneficial ownership of the securities held by DBI VIII, except to the extent of any pecuniary interest therein. /s/ Matthew T. Potter, Attorney-in-Fact for Delphi Management Partners VIII, L.L.C. 2016-03-23 /s/ Matthew T. Potter, Attorney-in-Fact for James Bochnowski 2016-03-23 /s/ Matthew T. Potter, Attorney-in-Fact for Delphi BioInvestments VIII, L.P. 2016-03-23 /s/ Matthew T. Potter, Attorney-in-Fact for Delphi Ventures VIII, L.P. 2016-03-23 /s/ Matthew T. Potter, Attorney-in-Fact for David Douglass 2016-03-23 /s/ Matthew T. Potter, Attorney-in-Fact for Deepika Pakianathan 2016-03-23 /s/ Matthew T. Potter, Attorney-in-Fact for Douglas A. Roeder 2016-03-23