0000899243-17-027103.txt : 20171120 0000899243-17-027103.hdr.sgml : 20171120 20171120215651 ACCESSION NUMBER: 0000899243-17-027103 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171120 FILED AS OF DATE: 20171120 DATE AS OF CHANGE: 20171120 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Adams Jan CENTRAL INDEX KEY: 0001722536 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38295 FILM NUMBER: 171215295 MAIL ADDRESS: STREET 1: BOXBERGRING 107 CITY: HEIDELBERG STATE: 2M ZIP: 69126 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Herr Stefan CENTRAL INDEX KEY: 0001722440 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38295 FILM NUMBER: 171215294 MAIL ADDRESS: STREET 1: BOXBERGRING CITY: HEIDELBERG STATE: 2M ZIP: 69126 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Muhlenbeck Frank CENTRAL INDEX KEY: 0001646114 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38295 FILM NUMBER: 171215293 MAIL ADDRESS: STREET 1: C/O CONFORMIS, INC. STREET 2: 28 CROSBY DRIVE CITY: BEDFORE STATE: MA ZIP: 01730 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: EMBL Technology Fund II GmbH & Co. KG CENTRAL INDEX KEY: 0001722607 STATE OF INCORPORATION: 2M FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38295 FILM NUMBER: 171215297 BUSINESS ADDRESS: STREET 1: BOXBERGRING 107 CITY: HEIDELBERG STATE: 2M ZIP: 69126 BUSINESS PHONE: 49-6221-389330 MAIL ADDRESS: STREET 1: BOXBERGRING 107 CITY: HEIDELBERG STATE: 2M ZIP: 69126 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: EMBL Ventures Verwaltungs GmbH CENTRAL INDEX KEY: 0001722603 STATE OF INCORPORATION: 2M FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38295 FILM NUMBER: 171215296 BUSINESS ADDRESS: STREET 1: BOXBERGRING 107 CITY: HEIDELBERG STATE: 2M ZIP: 69126 BUSINESS PHONE: 49-6221-389330 MAIL ADDRESS: STREET 1: BOXBERGRING 107 CITY: HEIDELBERG STATE: 2M ZIP: 69126 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Arsanis, Inc. CENTRAL INDEX KEY: 0001501697 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 273181608 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 890 WINTER STREET, SUITE 230 CITY: WALTHAM STATE: MA ZIP: 02451 BUSINESS PHONE: 781-819-5704 MAIL ADDRESS: STREET 1: 890 WINTER STREET, SUITE 230 CITY: WALTHAM STATE: MA ZIP: 02451 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-11-20 1 0001501697 Arsanis, Inc. ASNS 0001722607 EMBL Technology Fund II GmbH & Co. KG BOXBERGRING 107 HEIDELBERG 2M 69126 GERMANY 0 0 1 0 0001722603 EMBL Ventures Verwaltungs GmbH BOXBERGRING 107 HEIDELBERG 2M 69126 GERMANY 0 0 1 0 0001722536 Adams Jan BOXBERGRING 107 HEIDELBERG 2M 69126 GERMANY 0 0 1 0 0001722440 Herr Stefan BOXBERGRING 107 HEIDELBERG 2M 69126 GERMANY 0 0 1 0 0001646114 Muhlenbeck Frank BOXBERGRING 107 HEIDELBERG 69126 0 0 1 0 Common Stock 2017-11-20 4 C 0 103278 A 103278 D Common Stock 2017-11-20 4 C 0 247176 A 350454 D Common Stock 2017-11-20 4 P 0 20000 10.00 A 370454 D Series C Convertible Preferred Stock 2017-11-20 4 C 0 207253 0.00 D Common Stock 103278 0 D Series D Convertible Preferred Stock 2017-11-20 4 C 0 843613 0.00 D Common Stock 247176 0 D The Series C Convertible Preferred Stock converted into Common Stock on a 0.49832-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series C Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date. The Series D Convertible Preferred Stock converted into Common Stock on a 0.29300-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series D Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date. The reported securities are held of record by EMBL Technology Fund II GmbH & Co. KG ("EMBL"). EMBL Ventures Verwaltungs GmbH is the general partner of EMBL. Dr. Jan Adams, Dr. Frank Muhlenbeck and Dr. Stefan Herr are the Managing Directors of EMBL Ventures Verwaltungs GmbH. By virtue of such relationships, EMBL Ventures Verwaltungs GmbH, Dr. Adams, Dr. Frank Muhlenbeck and Dr. Herr may be deemed to have voting and investment power with respect to the securities held by EMBL. Each of EMBL Ventures Verwaltungs GmbH, Dr. Adams, Dr. Frank Muhlenbeck and Dr. Herr disclaims beneficial ownership of these securities and this report shall not be deemed to be an admission that any one of them is the beneficial owner of such securities for purposes of Section 16 or any other purpose, except to the extent of their pecuniary interest therein. /s/ Mike Gray, as attorney-in-fact on behalf of EMBL Technology Fund II GmbH & Co. KG 2017-11-20 /s/ Mike Gray, as attorney-in-fact on behalf of EMBL Ventures Verwaltungs GmbH 2017-11-20 /s/ Mike Gray, as attorney-in-fact on behalf of Stefan Herr 2017-11-20 /s/ Mike Gray, as attorney-in-fact on behalf of Jan Adams 2017-11-20 /s/ Mike Gray, as attorney-in-fact on behalf of Frank Muhlenbeck 2017-11-20