0001104659-15-049009.txt : 20150630
0001104659-15-049009.hdr.sgml : 20150630
20150630183333
ACCESSION NUMBER: 0001104659-15-049009
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: Tasik Temenggor Investments (Cayman Islands) Ltd
CENTRAL INDEX KEY: 0001646755
STATE OF INCORPORATION: E9
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37474
FILM NUMBER: 15962682
BUSINESS ADDRESS:
STREET 1: C/O XERAYA CAPITAL SDN BHD, 26.03-26.08
STREET 2: LEVEL 26, G TOWER, 199 JALAN TUN RAZAK
CITY: KUALA LUMPUR
STATE: N8
ZIP: 50400
BUSINESS PHONE: 603 2381 8700
MAIL ADDRESS:
STREET 1: C/O XERAYA CAPITAL SDN BHD, 26.03-26.08
STREET 2: LEVEL 26, G TOWER, 199 JALAN TUN RAZAK
CITY: KUALA LUMPUR
STATE: N8
ZIP: 50400
3
1
a3.xml
3
X0206
3
2015-06-30
0
0001305773
ConforMIS Inc
CFMS
0001646755
Tasik Temenggor Investments (Cayman Islands) Ltd
C/O XERAYA CAPITAL SDN BHD, 26.03-26.08
LEVEL 26, G TOWER, 199 JALAN TUN RAZAK
KUALA LUMPURM MALAYSIA
50400
0
0
1
0
Series E-1 Preferred Stock
Common Stock
656250
D
Series E-2 Preferred Stock
Common Stock
1218750
D
The Series E-1 Preferred Stock is convertible into 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 has no expiration date.
The Series E-2 Preferred Stock is convertible into 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 has no expiration date.
/s/ Farid Zahir, Director
2015-06-30