0000899243-17-017257.txt : 20170626 0000899243-17-017257.hdr.sgml : 20170626 20170626193156 ACCESSION NUMBER: 0000899243-17-017257 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170622 FILED AS OF DATE: 20170626 DATE AS OF CHANGE: 20170626 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Sientra, Inc. CENTRAL INDEX KEY: 0001551693 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 205551000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 420 SOUTH FAIRVIEW AVENUE STREET 2: SUITE 200 CITY: SANTA BARBARA STATE: CA ZIP: 93117 BUSINESS PHONE: 805.679.8838 MAIL ADDRESS: STREET 1: 420 SOUTH FAIRVIEW AVENUE STREET 2: SUITE 200 CITY: SANTA BARBARA STATE: CA ZIP: 93117 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Simon Nicholas CENTRAL INDEX KEY: 0001431403 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36709 FILM NUMBER: 17930929 MAIL ADDRESS: STREET 1: 101 MAIN STREET SUITE 1210 CITY: CAMBRIDGE STATE: MA ZIP: 02142 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-06-22 0 0001551693 Sientra, Inc. SIEN 0001431403 Simon Nicholas C/O 420 SOUTH FAIRVIEW, SUITE 200 SANTA BARBARA CA 93117 1 0 1 0 Common Stock 2017-06-22 4 A 0 12861 9.72 A 31546 D Common Stock 2730765 I See Note The common stock underlying this grant of restricted stock will vest on the earlier to occur of: (i) day prior to the annual meeting of stockholders for the year following the date of grant, or (ii) the one-year anniversary of the annual meeting of stockholders of the year of grant, subject to continued service as a director. Consists of 2,730,765 shares held of record by Clarus Lifesciences I, L.P., or Clarus I. Clarus Ventures I Management, L.P.,or Clarus I GPLP, is the sole general partner of Clarus I. Clarus Ventures I, LLC, or Clarus I GPLLC, is the sole general partner of Clarus I GPLP. Mr. Simon is a managing director of Clarus I GPLLC and may be deemed to beneficially own certain of the shares held of record by Clarus I. Mr. Simon disclaims beneficial ownership of all shares held of record by Clarus I, except to the extent of his pecuniary interest therein. /s/ Nicholas Simon 2017-06-26