0001019687-14-000490.txt : 20140212
0001019687-14-000490.hdr.sgml : 20140212
20140212192531
ACCESSION NUMBER: 0001019687-14-000490
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140211
FILED AS OF DATE: 20140212
DATE AS OF CHANGE: 20140212
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Eleven Biotherapeutics, Inc.
CENTRAL INDEX KEY: 0001485003
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 252025616
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 215 FIRST STREET
STREET 2: SUITE 400
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
BUSINESS PHONE: 617-871-9911
MAIL ADDRESS:
STREET 1: 215 FIRST STREET
STREET 2: SUITE 400
CITY: CAMBRIDGE
STATE: MA
ZIP: 02142
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: JAFCO Super V3 Investment Limited Partnership
CENTRAL INDEX KEY: 0001590442
STATE OF INCORPORATION: M0
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36296
FILM NUMBER: 14602297
BUSINESS ADDRESS:
STREET 1: OTEMACHI FIRST SQUARE, WEST TOWER 11F
STREET 2: 1-5-1 OTEMACHI
CITY: CHIYODA-KU, TOKYO 100-0004
STATE: M0
ZIP: 100-0004
BUSINESS PHONE: 81-3-5223-7008
MAIL ADDRESS:
STREET 1: OTEMACHI FIRST SQUARE, WEST TOWER 11F
STREET 2: 1-5-1 OTEMACHI
CITY: CHIYODA-KU, TOKYO 100-0004
STATE: M0
ZIP: 100-0004
4
1
jafco_f4.xml
OWNERSHIP DOCUMENT
X0306
4
2014-02-11
0
0001485003
Eleven Biotherapeutics, Inc.
EBIO
0001590442
JAFCO Super V3 Investment Limited Partnership
OTEMACHI FIRST SQUARE, WEST TOWER
11F, 1-5-1, OTENACHI CHIYODA-KU
TOKYO, JAPAN
M0
100-0004
JAPAN
0
0
1
0
Common Stock
2014-02-11
4
P
0
219790
10
A
219790
D
Common Stock
2014-02-11
4
C
0
1574803
A
1794593
D
Common Stock
2014-02-11
4
C
0
232105
A
2026698
D
Common Stock
2014-02-11
4
M
0
60853
A
2087551
D
Common Stock
2014-02-11
4
M
0
39740
A
2127291
D
Series A Preferred Stock
2014-02-11
4
C
0
1574803
0.00
D
Common Stock
1574803
0
D
Series B Preferred Stock
2014-02-11
4
C
0
232105
0.00
D
Common Stock
232105
0
D
Common Stock Warrant (right to purchase)
2014-02-11
4
M
0
61242
0.00
D
Common Stock
60853
0
D
Common Stock Warrant (right to purchase)
2014-02-11
4
M
0
39994
0.00
D
Common Stock
39740
0
D
The aggregate number of shares of Issuer's Preferred Stock held by the Reporting Person converted into Common Stock immediately prior to the closing of the Issuer's initial public offering and has no expiration date. These shares converted into Common Stock on a 1-for-1 basis.
The Reporting Person exercised warrants to purchase shares of Common Stock by cashless exercise immediately prior to the closing of the Issuer's initial public offering.
/s/ Hironori Hozoji
2014-02-12