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