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