0001104659-18-060328.txt : 20181003 0001104659-18-060328.hdr.sgml : 20181003 20181003162443 ACCESSION NUMBER: 0001104659-18-060328 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181001 FILED AS OF DATE: 20181003 DATE AS OF CHANGE: 20181003 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: 5AM VENTURES III, L.P. CENTRAL INDEX KEY: 0001456890 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38672 FILM NUMBER: 181105303 BUSINESS ADDRESS: STREET 1: 2200 SAND HILL ROAD STREET 2: SUITE 110 CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-233-8600 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD STREET 2: SUITE 110 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: 5AM Co-Investors III, L.P. CENTRAL INDEX KEY: 0001478660 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38672 FILM NUMBER: 181105304 BUSINESS ADDRESS: STREET 1: 2200 SAND HILL ROAD, SUITE 110 CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-233-8600 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD, SUITE 110 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: 5AM Partners III, LLC CENTRAL INDEX KEY: 0001555953 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38672 FILM NUMBER: 181105305 BUSINESS ADDRESS: STREET 1: 2200 SAND HILL ROAD STE 110 CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650.233.8600 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD STE 110 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ROCKLAGE SCOTT M CENTRAL INDEX KEY: 0001219014 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38672 FILM NUMBER: 181105306 MAIL ADDRESS: STREET 1: 179 SANDY POND ROAD CITY: LINCOLN STATE: MA ZIP: 01773 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DIEKMAN JOHN D CENTRAL INDEX KEY: 0001240357 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38672 FILM NUMBER: 181105307 MAIL ADDRESS: STREET 1: C/O 5 AM VENTURES STREET 2: 3000 SAND HILL RD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Schwab Andrew J. CENTRAL INDEX KEY: 0001598549 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38672 FILM NUMBER: 181105308 MAIL ADDRESS: STREET 1: C/O 5AM VENTURES, 2200 SAND HILL ROAD STREET 2: SUITE 110 CITY: MENLO PARK STATE: CA ZIP: 94025 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ARVINAS INC. CENTRAL INDEX KEY: 0001655759 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 472566120 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 395 WINCHESTER COMPANY, LLC STREET 2: 5 SCIENCE PARK CITY: NEW HAVEN STATE: CT ZIP: 06511 BUSINESS PHONE: 203-535-1456 MAIL ADDRESS: STREET 1: 395 WINCHESTER COMPANY, LLC STREET 2: 5 SCIENCE PARK CITY: NEW HAVEN STATE: CT ZIP: 06511 FORMER COMPANY: FORMER CONFORMED NAME: ARVINAS HOLDING COMPANY, LLC DATE OF NAME CHANGE: 20151015 4 1 a4.xml 4 X0306 4 2018-10-01 0 0001655759 ARVINAS INC. ARVN 0001456890 5AM VENTURES III, L.P. 501 2ND STREET, SUITE 350 SAN FRANCISCO CA 94107 0 0 1 0 0001478660 5AM Co-Investors III, L.P. 501 2ND STREET, SUITE 350 SAN FRANCISCO CA 94107 0 0 1 0 0001555953 5AM Partners III, LLC 501 2ND STREET, SUITE 350 SAN FRANCISCO CA 94107 0 0 1 0 0001219014 ROCKLAGE SCOTT M 501 2ND STREET, SUITE 350 SAN FRANCISCO CA 94107 0 0 1 0 0001240357 DIEKMAN JOHN D 501 2ND STREET, SUITE 350 SAN FRANCISCO CA 94107 0 0 1 0 0001598549 Schwab Andrew J. 501 2ND STREET, SUITE 350 SAN FRANCISCO CA 94107 0 0 1 0 Common Stock 2018-10-01 4 C 0 2862649 A 2862649 I See footnotes Common Stock 2018-10-01 4 C 0 1338679 A 4201328 I See footnotes Common Stock 2018-10-01 4 C 0 662864 A 4864192 I See footnotes Common Stock 2018-10-01 4 C 0 73777 A 73777 I See footnotes Common Stock 2018-10-01 4 C 0 34500 A 108277 I See footnotes Common Stock 2018-10-01 4 C 0 17083 A 125360 I See footnotes Series A Preferred Stock 2018-10-01 4 C 0 9303611 0.00 D Common Stock 2862649 0 I See Footnotes Series A Preferred Stock 2018-10-01 4 C 0 239776 0.00 D Common Stock 73777 0 I See Footnotes Series B Preferred Stock 2018-10-01 4 C 0 4350709 0.00 D Common Stock 1338679 0 I See Footnotes Series B Preferred Stock 2018-10-01 4 C 0 112128 0.00 D Common Stock 34500 0 I See Footnotes Series C Preferred Stock 2018-10-01 4 C 0 2154311 0.00 D Common Stock 662864 0 I See Footnotes Series C Preferred Stock 2018-10-01 4 C 0 55522 0.00 D Common Stock 17083 0 I See Footnotes These Secruties are held of record by 5AM Ventures III, L.P. ("Ventures III"). These Securities are held of record by 5AM Co-Investors III, L.P. ("Co-Investors III"). On October 1, 2018, the Series A Preferred Stock, Series B Preferred Stock and Series C Preferred Stock converted into Common Stock on a 3.25-for-one basis, upon the closing of the Issuer's initial public offering without payment of consideration. The Series A Preferred Stock, Series B Preferred Stock and Series C Preferred Stock were convertible at any time at the holder's election and automatically upon the closing of the Issuer's initial public offering. The shares had no expiration date. 5AM Partners III, LLC ("Partners III") is the sole general partner of Ventures III and Co-Investors III. Dr. John D. Diekman, Andrew J. Schwab and Dr. Scott M. Rocklage, are the managing members of Partners III, and may be deemed to have shared voting and investment power over the shares beneficially owned by Ventures III and Co-Investors III. Each of Partners III, Dr. Diekman, Mr. Schwab and Dr. Rocklage disclaim beneficial ownership of such shares except to the extent of its or his pecuniary interest therein. 5AM VENTURES III, L.P. By: 5AM Partners III, LLC, its General Partner /s/ Andrew J. Schwab 2018-10-03 5AM CO-INVESTORS III, L.P. By: 5AM Partners III, LLC, its General Partners /s/ Andrew J. Schwab 2018-10-03 5AM PARTNERS III, LLC /s/ Andrew J. Schwab 2018-10-03 /s/ Scott Rocklage 2018-10-03 /s/ John D. Diekman 2018-10-03 /s/ Andrew J. Schwab 2018-10-03