0001209191-18-025824.txt : 20180423
0001209191-18-025824.hdr.sgml : 20180423
20180423161647
ACCESSION NUMBER: 0001209191-18-025824
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180423
FILED AS OF DATE: 20180423
DATE AS OF CHANGE: 20180423
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Torres S. Edward
CENTRAL INDEX KEY: 0001552293
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38459
FILM NUMBER: 18769073
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38459
FILM NUMBER: 18769072
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38459
FILM NUMBER: 18769074
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38459
FILM NUMBER: 18769075
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2018-04-23
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
Common Stock
2018-04-23
4
C
0
3181817
A
3181817
I
By Fund
Common Stock
2018-04-23
4
P
0
266000
15.00
A
3447817
I
By Fund
Series A Preferred Stock
2018-04-23
4
C
0
7000000
D
Common Stock
3181817
0
I
By Fund
The Series A Preferred Stock automatically converted into the Issuer's common stock on a 2.2-for-1 basis at the closing of the Issuer's initial public
offering without payment or further consideration and had 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
2018-04-23
/s/ S. Edward Torres, Lilly Ventures Fund I, LLC
2018-04-23
/s/ S. Edward Torres
2018-04-23
/s/ Dr. Steven E. Hall
2018-04-23