0001179110-15-012248.txt : 20150817 0001179110-15-012248.hdr.sgml : 20150817 20150817193934 ACCESSION NUMBER: 0001179110-15-012248 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150626 FILED AS OF DATE: 20150817 DATE AS OF CHANGE: 20150817 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) 562-3500 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: 151059944 MAIL ADDRESS: STREET 1: 101 MAIN STREET SUITE 1210 CITY: CAMBRIDGE STATE: MA ZIP: 02142 4 1 edgar.xml FORM 4 - X0306 4 2015-06-26 0 0001551693 Sientra, Inc. SIEN 0001431403 Simon Nicholas C/O 420 SOUTH FAIRVIEW, SUITE 200 SANTA BARBARA CA 93117 1 0 1 0 Stock Option (right to buy) 25.18 2015-06-26 4 A 0 7037 0 A 2025-06-26 Common Stock 7037 7037 D This stock option grant will vest in 12 equal monthly installments following the grant date of June 26, 2015, subject to continued service as a director. Mr. Simon is a managing director of Clarus Ventures I, LLC and may be deemed to beneficially own certain of the shares held of record by Clarus Lifesciences I, L.P., or 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. Clarus Lifesciences I Management, L.P., or Clarus Ventures I GP, L.P., is the sole general partner of Clarus I. Clarus Ventures I, LLC is the sole general partner of Clarus Ventures I GP, L.P. /s/ Joel Smith, Attorney-in-fact for Nicholas Simon 2015-08-17