0000899243-17-027004.txt : 20171120
0000899243-17-027004.hdr.sgml : 20171120
20171120173252
ACCESSION NUMBER: 0000899243-17-027004
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171120
FILED AS OF DATE: 20171120
DATE AS OF CHANGE: 20171120
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gerngross Tillman U.
CENTRAL INDEX KEY: 0001722061
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38295
FILM NUMBER: 171214870
MAIL ADDRESS:
STREET 1: C/O ARSANIS, INC.
STREET 2: 890 WINTER STREET, SUITE 230
CITY: WALTHAM
STATE: MA
ZIP: 02451
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Arsanis, Inc.
CENTRAL INDEX KEY: 0001501697
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 273181608
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 890 WINTER STREET, SUITE 230
CITY: WALTHAM
STATE: MA
ZIP: 02451
BUSINESS PHONE: 781-819-5704
MAIL ADDRESS:
STREET 1: 890 WINTER STREET, SUITE 230
CITY: WALTHAM
STATE: MA
ZIP: 02451
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-11-20
0
0001501697
Arsanis, Inc.
ASNS
0001722061
Gerngross Tillman U.
C/O ARSANIS, INC.
890 WINTER STREET, SUITE 230
WALTHAM
MA
02451
1
0
0
0
Common Stock
2017-11-20
4
C
0
90272
A
192821
D
Common Stock
2017-11-20
4
P
0
200000
10.00
A
392821
D
Series D Convertible Preferred Stock
2017-11-20
4
C
0
308099
0.00
D
Common Stock
90272
0
D
The Series D Convertible Preferred Stock converted into Common Stock on a 0.29300-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series D Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date.
/s/ Mike Gray, attorney-in-fact
2017-11-20