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