0000903423-15-000426.txt : 20150630
0000903423-15-000426.hdr.sgml : 20150630
20150630175932
ACCESSION NUMBER: 0000903423-15-000426
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150630
FILED AS OF DATE: 20150630
DATE AS OF CHANGE: 20150630
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: ConforMIS Inc
CENTRAL INDEX KEY: 0001305773
STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
BUSINESS ADDRESS:
STREET 1: 28 CROSBY DR.
CITY: BEDFORD
STATE: MA
ZIP: 01730
BUSINESS PHONE: (781) 345-9001
MAIL ADDRESS:
STREET 1: 28 CROSBY DR.
CITY: BEDFORD
STATE: MA
ZIP: 01730
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Procific
CENTRAL INDEX KEY: 0001362557
STATE OF INCORPORATION: E9
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37474
FILM NUMBER: 15962531
BUSINESS ADDRESS:
STREET 1: P.O. BOX 7106
CITY: EMIRATE OF ABU DHABI
STATE: C0
ZIP: 00000
BUSINESS PHONE: (202) 457-6325
MAIL ADDRESS:
STREET 1: P.O. BOX 7106
CITY: EMIRATE OF ABU DHABI
STATE: C0
ZIP: 00000
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Abu Dhabi Investment Authority
CENTRAL INDEX KEY: 0001362558
STATE OF INCORPORATION: C0
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37474
FILM NUMBER: 15962532
BUSINESS ADDRESS:
STREET 1: 211 CORNICHE
STREET 2: PO BOX 3600
CITY: ABU DHABI
STATE: C0
ZIP: 0000
BUSINESS PHONE: 971 2 4154242
MAIL ADDRESS:
STREET 1: P.O. BOX 3600
CITY: ABU DHABI
STATE: C0
ZIP: 0000
3
1
adiaprof3.xml
OWNERSHIP DOCUMENT
X0206
3
2015-06-30
0
0001305773
ConforMIS Inc
CFMS
0001362558
Abu Dhabi Investment Authority
211 CORNICHE STREET
PO BOX 3600
EMIRATE OF ABU DHABI
C0
3600
UNITED ARAB EMIRATES
1
0
1
0
0001362557
Procific
122 MARY STREET
PO BOX 709
GRAND CAYMAN
E9
KY1-1107
CAYMAN ISLANDS
1
0
1
0
Series E-1 Preferred Stock
Common Stock
1562500
D
Series E-2 Preferred Stock
Common Stock
1562500
D
The Series E-1 Preferred Stock and Series E-2 Preferred Stock are convertible into common stock, par value of $0.00001 per share (the "Common Stock") on a two-for-one basis into the number of shares of Common Stock as shown in Column 3 at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and have no expiration date.
Procific directly holds E-1 Preferred Stock convertible into 1,562,500 shares of Common Stock and E-2 Preferred Stock convertible into 1,562,500 shares of Common Stock (collectively, the "Procific Shares"). The Abu Dhabi Investment Authority ("ADIA" and, together with Procific, the "Reporting Persons") is the sole owner of Procific and therefore may also be deemed to beneficially own the Procific Shares.
Pursuant to Rule 16a-1(a)(4) under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), this filing shall not be deemed an admission that the Reporting Persons are, for purposes of Section 16 of the Exchange Act or otherwise, the beneficial owners of any equity securities in excess of their respective pecuniary interests.
Solely for the purposes of Section 16 of the Exchange Act, each of the Reporting Persons may be deemed a "deputized director" by virtue of Colm Lanigan, an employee of ADIA, serving as a member of the board of directors of the Issuer.
/s/ Ahmed Al Mosa, Authorized Signatory of Abu Dhabi Investment Authority
2015-06-30
/s/ Khalifa AlFalasi, Authorized Signatory of Abu Dhabi Investment Authority
2015-06-30
/s/ Hamad Shahwan AlDhaheri, Authorized Signatory of Procific
2015-06-30
/s/ Ahmed Ghubash, Authorized Signatory of Procific
2015-06-30