0001104659-16-130143.txt : 20160629 0001104659-16-130143.hdr.sgml : 20160629 20160629164451 ACCESSION NUMBER: 0001104659-16-130143 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160627 FILED AS OF DATE: 20160629 DATE AS OF CHANGE: 20160629 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SELECTA BIOSCIENCES INC CENTRAL INDEX KEY: 0001453687 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 480 ARSENAL STREET STREET 2: BUILDING ONE CITY: WATERTOWN STATE: MA ZIP: 02472 BUSINESS PHONE: 617-923-1400 MAIL ADDRESS: STREET 1: 480 ARSENAL STREET STREET 2: BUILDING ONE CITY: WATERTOWN STATE: MA ZIP: 02472 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Polaris Venture Partners Special Founders' Fund V, L.P. CENTRAL INDEX KEY: 0001439586 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37798 FILM NUMBER: 161739319 BUSINESS ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 BUSINESS PHONE: 781-290-0770 MAIL ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Polaris Venture Partners Founders' Fund V, L.P. CENTRAL INDEX KEY: 0001439588 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37798 FILM NUMBER: 161739320 BUSINESS ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 BUSINESS PHONE: 781-290-0770 MAIL ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Polaris Venture Partners Entrepreneurs' Fund V, L.P. CENTRAL INDEX KEY: 0001439587 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37798 FILM NUMBER: 161739321 BUSINESS ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 BUSINESS PHONE: 781-290-0770 MAIL ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Polaris Venture Partners V, L.P. CENTRAL INDEX KEY: 0001439590 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37798 FILM NUMBER: 161739322 BUSINESS ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 BUSINESS PHONE: 781-290-0770 MAIL ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Polaris Venture Management Co. V, L.L.C. CENTRAL INDEX KEY: 0001439589 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37798 FILM NUMBER: 161739323 BUSINESS ADDRESS: STREET 1: ONE MARINA PARK DRIVE STREET 2: 10TH FLOOR CITY: BOSTON STATE: MA ZIP: 02210 BUSINESS PHONE: 781-290-0770 MAIL ADDRESS: STREET 1: ONE MARINA PARK DRIVE STREET 2: 10TH FLOOR CITY: BOSTON STATE: MA ZIP: 02210 4 1 a4.xml 4 X0306 4 2016-06-27 0 0001453687 SELECTA BIOSCIENCES INC SELB 0001439589 Polaris Venture Management Co. V, L.L.C. ONE MARINA PARK DRIVE, 10TH FL. BOSTON MA 02210 0 0 1 0 0001439590 Polaris Venture Partners V, L.P. ONE MARINA PARK DRIVE, 10TH FL. BOSTON MA 02210 0 0 1 0 0001439587 Polaris Venture Partners Entrepreneurs' Fund V, L.P. ONE MARINA PARK DRIVE, 10TH FL. BOSTON MA 02210 0 0 1 0 0001439588 Polaris Venture Partners Founders' Fund V, L.P. ONE MARINA PARK DRIVE, 10TH FL. BOSTON MA 02210 0 0 1 0 0001439586 Polaris Venture Partners Special Founders' Fund V, L.P. ONE MARINA PARK DRIVE, 10TH FL. BOSTON MA 02210 0 0 1 0 Common Stock 2016-06-27 4 C 0 32207 0 A 32972 I See Footnote Common Stock 2016-06-27 4 C 0 11318 0 A 11586 I See Footnote Common Stock 2016-06-27 4 C 0 16524 0 A 16916 I See Footnote Common Stock 2016-06-27 4 C 0 1652646 0 A 1691963 I See Footnote Common Stock 2016-06-27 4 P 0 2821 14.00 A 35793 I See Footnote Common Stock 2016-06-27 4 P 0 991 14.00 A 12577 I See Footnote Common Stock 2016-06-27 4 P 0 1448 14.00 A 18364 I See Footnote Common Stock 2016-06-27 4 P 0 144740 14.00 A 1836703 I See Footnote Series A Convertible Preferred Stock 2016-06-27 4 C 0 6494 0 D Common Stock 6494 0 I See Footnote Series A Convertible Preferred Stock 2016-06-27 4 C 0 2282 0 D Common Stock 2282 0 I See Footnote Series A Convertible Preferred Stock 2016-06-27 4 C 0 3332 0 D Common Stock 3332 0 I See Footnote Series A Convertible Preferred Stock 2016-06-27 4 C 0 333207 0 D Common Stock 333207 0 I See Footnote Series B Convertible Preferred Stock 2016-06-27 4 C 0 11875 0 D Common Stock 11875 0 I See Footnote Series B Convertible Preferred Stock 2016-06-27 4 C 0 4174 0 D Common Stock 4174 0 I See Footnote Series B Convertible Preferred Stock 2016-06-27 4 C 0 6093 0 D Common Stock 6093 0 I See Footnote Series B Convertible Preferred Stock 2016-06-27 4 C 0 609316 0 D Common Stock 609316 0 I See Footnote Series C Convertible Preferred Stock 2016-06-27 4 C 0 4420 0 D Common Stock 4420 0 I See Footnote Series C Convertible Preferred Stock 2016-06-27 4 C 0 1553 0 D Common Stock 1553 0 I See Footnote Series C Convertible Preferred Stock 2016-06-27 4 C 0 2267 0 D Common Stock 2267 0 I See Footnote Series C Convertible Preferred Stock 2016-06-27 4 C 0 226801 0 D Common Stock 226801 0 I See Footnote Series D Convertible Preferred Stock 2016-06-27 4 C 0 4647 0 D Common Stock 4647 0 I See Footnote Series D Convertible Preferred Stock 2016-06-27 4 C 0 1632 0 D Common Stock 1632 0 I See Footnote Series D Convertible Preferred Stock 2016-06-27 4 C 0 2384 0 D Common Stock 2384 0 I See Footnote Series D Convertible Preferred Stock 2016-06-27 4 C 0 238470 0 D Common Stock 238470 0 I See Footnote Series E Convertible Preferred Stock 2016-06-27 4 C 0 3078 0 D Common Stock 4771 0 I See Footnote Series E Convertible Preferred Stock 2016-06-27 4 C 0 1082 0 D Common Stock 1677 0 I See Footnote Series E Convertible Preferred Stock 2016-06-27 4 C 0 1579 0 D Common Stock 2448 0 I See Footnote Series E Convertible Preferred Stock 2016-06-27 4 C 0 157957 0 D Common Stock 244852 0 I See Footnote The reportable securities are owned directly by Polaris Venture Partners Entrepreneurs' Fund V, L.P. ("PVPE V"). Polaris Venture Management Co. V, L.L.C. ("PVM V") is the general partner of PVPE V. PVM V disclaims beneficial ownership of these securities and this report shall not be deemed an admission that PVM V is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of its pecuniary interest therein. Each of Jonathan A. Flint ("Flint") and Terrance G. McGuire ("McGuire") are the managing members of PVM V. Amir Nashat ("Nashat"), who is a member of the Issuer's Board of Directors, is a member of PVM V. Each of Flint, McGuire and Nashat, in their respective capacities with regard to PVM V, may be deemed to have shared voting and dispositive power of the shares held by PVPE V. Each of Flint, McGuire and Nashat disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their pecuniary interest therein. The reportable securities are owned directly by Polaris Venture Partners Founders' Fund V, L.P. ("PVPFF V"). PVM V is the general partner of PVPFF V. PVM V disclaims beneficial ownership of these securities and this report shall not be deemed an admission that PVM V is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of its pecuniary interest therein. Each of Flint and McGuire are the managing members of PVM V. Nashat, who is a member of the Issuer's Board of Directors, is a member of PVM V. Each of Flint, McGuire and Nashat, in their respective capacities with regard to PVM V, may be deemed to have shared voting and dispositive power of the shares held by PVPFF V. Each of Flint, McGuire and Nashat disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their pecuniary interest therein. The reportable securities are owned directly by Polaris Venture Partners Special Founders' Fund V, L.P. ("PVPSFF V"). PVM V is the general partner of PVPSFF V. PVM V disclaims beneficial ownership of these securities and this report shall not be deemed an admission that PVM V is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of its pecuniary interest therein. Each of Flint and McGuire are the managing members of PVM V. Nashat, who is a member of the Issuer's Board of Directors, is a member of PVM V. Each of Flint, McGuire and Nashat, in their respective capacities with regard to PVM V, may be deemed to have shared voting and dispositive power of the shares held by PVPSFF V. Each of Flint, McGuire and Nashat disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their pecuniary interest therein. The reportable securities are owned directly by Polaris Venture Partners V, L.P. ("PVP V"). PVM V is the general partner of PVP V. PVM V disclaims beneficial ownership of these securities and this report shall not be deemed an admission that PVM V is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of its pecuniary interest therein. Each of Flint and McGuire are the managing members of PVM V. Nashat, who is a member of the Issuer's Board of Directors, is a member of PVM V. Each of Flint, McGuire and Nashat, in their respective capacities with regard to PVM V, may be deemed to have shared voting and dispositive power of the shares held by PVP V. Each of Flint, McGuire and Nashat disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their pecuniary interest therein. The preferred stock is convertible at any time, at the holder's election and has no expiration date. The preferred stock automatically converted into common stock on a 1-for-1 basis upon the closing of the Issuer's initial public offering. The Series E Convertible Preferred Stock is convertible at any time, at the holder's election and has no expiration date. The Series E Convertible Preferred Stock automatically converted into common stock on an approximately 1-for-1.550115 basis upon the closing of the Issuer's initial public offering. /s/ Mary Blair, Attorney-in-Fact for Polaris Venture Management Co. V, L.L.C. 2016-06-29 /s/ Mary Blair, Attorney-in-Fact for Polaris Venture Management Co. V, L.L.C., general partner of Polaris Venture Partners V, L.P. 2016-06-29 /s/ Mary Blair, Attorney-in-Fact for Polaris Venture Management Co. V, L.L.C., general partner of Polaris Venture Partners Entrepreneurs' Fund V, L.P. 2016-06-29 /s/ Mary Blair, Attorney-in-Fact for Polaris Venture Management Co. V, L.L.C., general partner of Polaris Venture Partners Founders' Fund V, L.P. 2016-06-29 /s/ Mary Blair, Attorney-in-Fact for Polaris Venture Management Co. V, L.L.C., general partner of Polaris Venture Partners Special Founders' Fund V, L.P. 2016-06-29