0001019687-14-000409.txt : 20140206
0001019687-14-000409.hdr.sgml : 20140206
20140206171012
ACCESSION NUMBER: 0001019687-14-000409
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140205
FILED AS OF DATE: 20140206
DATE AS OF CHANGE: 20140206
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Eleven Biotherapeutics, Inc.
CENTRAL INDEX KEY: 0001485003
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 252025616
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 215 FIRST STREET
STREET 2: SUITE 400
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
BUSINESS PHONE: 617-871-9911
MAIL ADDRESS:
STREET 1: 215 FIRST STREET
STREET 2: SUITE 400
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: JAFCO Super V3 Investment Limited Partnership
CENTRAL INDEX KEY: 0001590442
STATE OF INCORPORATION: M0
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36296
FILM NUMBER: 14580971
BUSINESS ADDRESS:
STREET 1: OTEMACHI FIRST SQUARE, WEST TOWER 11F
STREET 2: 1-5-1 OTEMACHI
CITY: CHIYODA-KU, TOKYO 100-0004
STATE: M0
ZIP: 100-0004
BUSINESS PHONE: 81-3-5223-7008
MAIL ADDRESS:
STREET 1: OTEMACHI FIRST SQUARE, WEST TOWER 11F
STREET 2: 1-5-1 OTEMACHI
CITY: CHIYODA-KU, TOKYO 100-0004
STATE: M0
ZIP: 100-0004
3
1
jafco_frm3.xml
FORM 3
X0206
3
2014-02-05
0
0001485003
Eleven Biotherapeutics, Inc.
EBIO
0001590442
JAFCO Super V3 Investment Limited Partnership
OTEMACHI FIRST SQUARE, WEST TOWER 11F
CHIYODA-KU, TOKYO 100-0004
M0
100-0004
JAPAN
0
0
1
0
Series A Preferred Stock
0
Common Stock
1574803
D
Series B Preferred Stock
0
Common Stock
232105
D
Common Stock Warrant (right to purchase)
0.0635
Common Stock
61242
D
Common Stock Warrant (right to purchase)
0.0635
Common Stock
39994
D
The Series A Preferred Stock is convertible into Common Stock on an 6.35-for-one basis into the number of shares of Common Stock as shown in column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date.
The Series B Preferred Stock is convertible into Common Stock on an 6.35-for-one basis into the number of shares of Common Stock as shown in column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date.
The Warrant to purchase Common Stock as shown in column 3 is exercisable at any time at the holder's election prior to June 28, 2018, and automatically upon the closing of the Issuer's initial public offering.
The Warrant to purchase Common Stock as shown in column 3 is exercisable at any time at the holder's election prior to December 6, 2018, and automatically upon the closing of the Issuer's initial public offering.
/s/ Hironori Hozoji
2014-02-06