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