0001209191-18-025384.txt : 20180418
0001209191-18-025384.hdr.sgml : 20180418
20180418165258
ACCESSION NUMBER: 0001209191-18-025384
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180418
FILED AS OF DATE: 20180418
DATE AS OF CHANGE: 20180418
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Torres S. Edward
CENTRAL INDEX KEY: 0001552293
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38459
FILM NUMBER: 18761635
MAIL ADDRESS:
STREET 1: C/O LILLY VENTURES FUND I LLC
STREET 2: 115 W. WASHINGTON ST, STE 1680 SOUTH
CITY: INDIANAPOLIS
STATE: IN
ZIP: 46204
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hall Steven Edward
CENTRAL INDEX KEY: 0001602732
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38459
FILM NUMBER: 18761634
MAIL ADDRESS:
STREET 1: 15001 BARNHARDT CT
CITY: CHAPEL HILL
STATE: NC
ZIP: 27517
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lilly Ventures Fund I LLC
CENTRAL INDEX KEY: 0001575852
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38459
FILM NUMBER: 18761636
BUSINESS ADDRESS:
STREET 1: 115 W WASHINGTON STREET
STREET 2: SUITE 1680 SOUTH
CITY: INDIANAPOLIS
STATE: IN
ZIP: 46204
BUSINESS PHONE: (317) 429-0140
MAIL ADDRESS:
STREET 1: 115 W WASHINGTON STREET
STREET 2: SUITE 1680 SOUTH
CITY: INDIANAPOLIS
STATE: IN
ZIP: 46204
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LV Management Group, LLC
CENTRAL INDEX KEY: 0001681884
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38459
FILM NUMBER: 18761637
BUSINESS ADDRESS:
STREET 1: 115 WEST WASHINGTON STREET
STREET 2: SUITE 1680 - SOUTH
CITY: INDIANAPOLIS
STATE: IN
ZIP: 46204
BUSINESS PHONE: (317) 429-0140
MAIL ADDRESS:
STREET 1: 115 WEST WASHINGTON STREET
STREET 2: SUITE 1680 - SOUTH
CITY: INDIANAPOLIS
STATE: IN
ZIP: 46204
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Surface Oncology, Inc.
CENTRAL INDEX KEY: 0001718108
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 50 HAMPSHIRE STREET, 8TH FLOOR
CITY: CAMBRIDGE
STATE: MA
ZIP: 02139
BUSINESS PHONE: 617-714-4096
MAIL ADDRESS:
STREET 1: 50 HAMPSHIRE STREET, 8TH FLOOR
CITY: CAMBRIDGE
STATE: MA
ZIP: 02139
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2018-04-18
0
0001718108
Surface Oncology, Inc.
SURF
0001681884
LV Management Group, LLC
115 WEST WASHINGTON STREET
SUITE 1680-SOUTH
INDIANAPOLIS
IN
46204
0
0
1
0
0001575852
Lilly Ventures Fund I LLC
115 WEST WASHINGTON STREET
SUITE 1680-SOUTH
INDIANAPOLIS
IN
46204
0
0
1
0
0001552293
Torres S. Edward
115 WEST WASHINGTON STREET
SUITE 1680-SOUTH
INDIANAPOLIS
IN
46204
0
0
1
0
0001602732
Hall Steven Edward
115 WEST WASHINGTON STREET
SUITE 1680-SOUTH
INDIANAPOLIS
IN
46204
0
0
1
0
Series A Preferred Stock
Common Stock
3181817
I
By Fund
The Series A Preferred Stock is convertible on a 2.2-for-1 basis into Common Stock at any time at the election of the Reporting Person and will automatically convert upon the closing of the Issuer's initial public offering into the number of shares of the Issuer's Common Stock shown in column 3 without payment or further consideration. The shares have no expiration date.
These shares are held directly by Lilly Ventures Fund I, LLC (LVFI). LV Management Group, LLC (LVMG) is the management company for LVFI and has voting and dispositive power over the shares held by LVFI. As such, LVMG may be deemed to indirectly beneficially own the shares held by LVFI. LVMG's voting and dispositive decisions with respect to the shares held by LVFI are made by LVMG's management committee, which consists of S. Edward Torres, Dr. Steven E. Hall and Dr. Armen B. Shanafelt. Each of the individuals and entities listed above expressly disclaims beneficial ownership of the shares held by LVFI, except to the extent of his or its pecuniary interest therein. Dr. Shanafelt is a director of the Issuer and, accordingly, files separate Section 16 reports.
/s/ S. Edward Torres, LV Management Group, LLC
2018-04-18
/s/ S. Edward Torres, Lilly Ventures Fund I, LLC
2018-04-18
/s/ S. Edward Torres
2018-04-18
/s/ Dr. Steven E. Hall
2018-04-18