0001140361-17-038920.txt : 20171017 0001140361-17-038920.hdr.sgml : 20171017 20171017184306 ACCESSION NUMBER: 0001140361-17-038920 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171016 FILED AS OF DATE: 20171017 DATE AS OF CHANGE: 20171017 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Simon Nicholas CENTRAL INDEX KEY: 0001431403 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141513 MAIL ADDRESS: STREET 1: 101 MAIN STREET SUITE 1210 CITY: CAMBRIDGE STATE: MA ZIP: 02142 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GALAKATOS NICHOLAS CENTRAL INDEX KEY: 0001252522 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141514 MAIL ADDRESS: STREET 1: THE JOHN HANCOCK TOWER STREET 2: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HENNER DENNIS CENTRAL INDEX KEY: 0001249153 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141511 MAIL ADDRESS: STREET 1: THE JOHN HANCOCK TOWER STREET 2: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LIPTAK ROBERT CENTRAL INDEX KEY: 0001252523 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141510 MAIL ADDRESS: STREET 1: THE JOHN HANCOCK TOWER STREET 2: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WHEELER KURT CENTRAL INDEX KEY: 0001252525 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141512 MAIL ADDRESS: STREET 1: 801 GATEWAY BLVD STREET 2: STE 410 CITY: SAN FRANCISCO STATE: CA ZIP: 94080 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Clarus Ventures II, LLC CENTRAL INDEX KEY: 0001431437 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141515 BUSINESS ADDRESS: STREET 1: 101 MAIN STREET STREET 2: SUITE 1210 CITY: CAMBRIDGE STATE: MA ZIP: 02142 BUSINESS PHONE: 617-949-2200 MAIL ADDRESS: STREET 1: 101 MAIN STREET STREET 2: SUITE 1210 CITY: CAMBRIDGE STATE: MA ZIP: 02142 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Clarus Ventures II GP, L.P. CENTRAL INDEX KEY: 0001431439 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141516 BUSINESS ADDRESS: STREET 1: 101 MAIN STREET STREET 2: SUITE 1210 CITY: CAMBRIDGE STATE: MA ZIP: 02142 BUSINESS PHONE: 617-949-2200 MAIL ADDRESS: STREET 1: 101 MAIN STREET STREET 2: SUITE 1210 CITY: CAMBRIDGE STATE: MA ZIP: 02142 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Clarus Lifesciences II, L.P. CENTRAL INDEX KEY: 0001431443 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38238 FILM NUMBER: 171141518 BUSINESS ADDRESS: STREET 1: 101 MAIN STREET STREET 2: SUITE 1210 CITY: CAMBRIDGE STATE: MA ZIP: 02142 BUSINESS PHONE: 617-949-2200 MAIL ADDRESS: STREET 1: 101 MAIN STREET STREET 2: SUITE 1210 CITY: CAMBRIDGE STATE: MA ZIP: 02142 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Restoration Robotics Inc CENTRAL INDEX KEY: 0001409269 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 061681204 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 128 BAYTECH DRIVE CITY: SAN JOSE STATE: CA ZIP: 95134 BUSINESS PHONE: 408-883-6888 MAIL ADDRESS: STREET 1: 128 BAYTECH DRIVE CITY: SAN JOSE STATE: CA ZIP: 95134 4 1 doc1.xml FORM 4 X0306 4 2017-10-16 0 0001409269 Restoration Robotics Inc HAIR 0001431443 Clarus Lifesciences II, L.P. 101 MAIN STREET SUITE 1210 CAMBRIDGE MA 02142 0 0 1 0 0001431439 Clarus Ventures II GP, L.P. 101 MAIN STREET SUITE 1210 CAMBRIDGE MA 02142 0 0 1 0 0001431437 Clarus Ventures II, LLC 101 MAIN STREET SUITE 1210 CAMBRIDGE MA 02142 0 0 1 0 0001252522 GALAKATOS NICHOLAS 101 MAIN STREET, SUITE 1210 CAMBRIDGE MA 02142 0 0 1 0 0001431403 Simon Nicholas 101 MAIN STREET, SUITE 1210 CAMBRIDGE MA 02142 0 0 1 0 0001252525 WHEELER KURT 101 MAIN STREET, SUITE 1210 CAMBRIDGE MA 02142 0 0 1 0 0001249153 HENNER DENNIS 101 MAIN STREET, SUITE 1210 CAMBRIDGE MA 02142 0 0 1 0 0001252523 LIPTAK ROBERT 101 MAIN STREET, SUITE 1210 CAMBRIDGE MA 02142 0 0 1 0 Common Stock 2017-10-16 4 C 0 3389105 A 3389105 D Common Stock 2017-10-16 4 C 0 180881 7 A 3569986 D Series C Preferred Stock 2017-10-16 4 C 0 3389105 D Common Stock 3389105 0 D Convertible Promissory Note 7 2017-10-16 4 C 0 1259269.79 D Common Stock 180881 0 D The shares of the Issuer's Preferred Stock automatically converted into shares of the Issuer's Common Stock, for no additional consideration, on a 1:1 basis immediately prior to the consummation of the Issuer's Initial Public Offering (the "IPO"). The shares are directly held by Clarus Lifesciences II, L.P. ("Clarus"). Clarus Ventures II GP, L.P. (the "GPLP"), as the sole general partner of Clarus, may be deemed to beneficially own certain of the shares held by Clarus. Clarus Ventures II, LLC (the "GPLLC"), as the sole general partner of the GPLP, may be deemed to beneficially own certain of the shares held by Clarus. Each of he GPLP and the GPLLC disclaim beneficial ownership of all shares held by Clarus in which it does not have an actual pecuniary interest. The expiration date is not relevant to the conversion of these securities. The amount reported in column 5 is the principal amount of Reporting Person's Convertible Promissory Note (the "Note"). The outstanding principal and accrued interest of the Note automatically converted into shares of the Issuer's Common Stock at the price per share available to the public as set forth in the final prospectus related to the Issuer's IPO upon the closing of the IPO. /s/ Robert Liptak, Attorney-in-Fact for Clarus Lifesciences II, L.P. 2017-10-16 /s/ Robert Liptak, Attorney-in-Fact Clarus Ventures II GP, L.P. 2017-10-16 /s/ Robert Liptak, Attorney-in-Fact for Clarus Ventures II, LLC 2017-10-16 /s/ Robert Liptak, Attorney-in-Fact for Nicholas Galakatos 2017-10-16 /s/ Robert Liptak, Attorney-in-Fact for Nicholas Simon 2017-10-16 /s/ Robert Liptak, Attorney-in-Fact for Kurt Wheeler 2017-10-16 /s/ Robert Liptak, Attorney-in-Fact for Dennis Henner 2017-10-16 /s/ Robert Liptak 2017-10-16