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