0001104659-16-130148.txt : 20160629 0001104659-16-130148.hdr.sgml : 20160629 20160629164705 ACCESSION NUMBER: 0001104659-16-130148 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160627 FILED AS OF DATE: 20160629 DATE AS OF CHANGE: 20160629 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SELECTA BIOSCIENCES INC CENTRAL INDEX KEY: 0001453687 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 480 ARSENAL STREET STREET 2: BUILDING ONE CITY: WATERTOWN STATE: MA ZIP: 02472 BUSINESS PHONE: 617-923-1400 MAIL ADDRESS: STREET 1: 480 ARSENAL STREET STREET 2: BUILDING ONE CITY: WATERTOWN STATE: MA ZIP: 02472 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Osage Partners, LLC CENTRAL INDEX KEY: 0001677536 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37798 FILM NUMBER: 161739354 BUSINESS ADDRESS: STREET 1: 50 MONUMENT RD., SUITE 201 CITY: BALA CYNWYD STATE: PA ZIP: 19004 BUSINESS PHONE: 484 270 3260 MAIL ADDRESS: STREET 1: 50 MONUMENT RD., SUITE 201 CITY: BALA CYNWYD STATE: PA ZIP: 19004 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Osage University GP II, L.P. CENTRAL INDEX KEY: 0001677537 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37798 FILM NUMBER: 161739355 BUSINESS ADDRESS: STREET 1: 50 MONUMENT RD., SUITE 201 CITY: BALA CYNWYD STATE: PA ZIP: 19004 BUSINESS PHONE: 484 270 3260 MAIL ADDRESS: STREET 1: 50 MONUMENT RD., SUITE 201 CITY: BALA CYNWYD STATE: PA ZIP: 19004 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Osage University Partners II, L.P. CENTRAL INDEX KEY: 0001621636 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37798 FILM NUMBER: 161739356 BUSINESS ADDRESS: STREET 1: 50 MONUMENT ROAD CITY: BALA CYNWYD STATE: PA ZIP: 19004 BUSINESS PHONE: 484-434-2255 MAIL ADDRESS: STREET 1: 50 MONUMENT ROAD CITY: BALA CYNWYD STATE: PA ZIP: 19004 4 1 a4.xml 4 X0306 4 2016-06-27 1 0001453687 SELECTA BIOSCIENCES INC SELB 0001621636 Osage University Partners II, L.P. 50 MONUMENT ROAD, SUITE 201 BALA CYNWYD PA 19004 0 0 1 0 0001677537 Osage University GP II, L.P. 50 MONUMENT ROAD, SUITE 201 BALA CYNWYD PA 19004 0 0 1 0 0001677536 Osage Partners, LLC 50 MONUMENT ROAD, SUITE 201 BALA CYNWYD PA 19004 0 0 1 0 Common Stock 2016-06-27 4 C 0 441628 0 A 512543 I See Footnote Common Stock 2016-06-27 4 P 0 350000 14.00 A 862543 I See Footnote Series E Convertible Preferred Stock 2016-06-27 4 C 0 284900 0 D Common Stock 441628 0 I See Footnote Held by Osage University Partners II, L.P. ("Osage"). Osage Partners, LLC ("Osage Partners") is the general parter of Osage University GP II, LP ("Osage GP"), which is the general partner of Osage. Osage Partners and Osage GP may be deemed to share voting and investment power with respect to all shares held by Osage. Each of the filing persons disclaims beneficial ownership of the securities reported herein except to the extent of their pecuniary interest therein. The Series E Convertible Preferred Stock is convertible at any time, at the holder's election and has no expiration date. The Series E Convertible Preferred Stock automatically converted into common stock on an approximately 1-for-1.550115 basis upon the closing of the Issuer's initial public offering. OSAGE UNIVERSITY PARTNERS II, L.P. By: Osage University GP II, LP, its GP By: Osage Partners, LLC, its GP By: /s/ William Harrington, Member 2016-06-29 OSAGE UNIVERSITY GP II, LP By: Osage Partners, LLC, its GP By: /s/ William Harrington, Member 2016-06-29 OSAGE PARTNERS, LLC By: /s/ William Harrington, Member 2016-06-29