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