SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Smith Joel S.

(Last) (First) (Middle)
420 SOUTH FAIRVIEW,
SUITE 200

(Street)
SANTA BARBARA CA 93117

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/28/2014
3. Issuer Name and Ticker or Trading Symbol
Sientra, Inc. [ SIEN ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
GC, Secretary and CCO
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) (1) 07/09/2017 Common Stock 38,545 $1.65 D
Employee Stock Option (right to buy) (2) 01/14/2019 Common Stock 16,000 $2.338 D
Employee Stock Option (right to buy) (3) 04/18/2022 Common Stock 29,090 $3.988 D
Employee Stock Option (right to buy) (4) 04/24/2024 Common Stock 12,727 $11 D
Explanation of Responses:
1. This stock option is fully vested.
2. This stock option is fully vested.
3. This stock option vests as follows: 1/4 vested on March 9, 2013, with the balance vesting in approximately equal installments on the last day of each full month following March 9, 2013 through February 29, 2016.
4. This stock option vests as follows: 1/4 vested on January 15, 2010, with the balance vesting in approximately equal installments on the last day of each full month following January 1, 2015 through June 30, 2015.
Remarks:
Exhibit 24. Power of Attorney for Joel Smith.
/s/ Joel Smith 10/28/2014
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.