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