0001181431-14-022745.txt : 20140623 0001181431-14-022745.hdr.sgml : 20140623 20140604193118 ACCESSION NUMBER: 0001181431-14-022745 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140603 FILED AS OF DATE: 20140604 DATE AS OF CHANGE: 20140604 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Foundation Medicine, Inc. CENTRAL INDEX KEY: 0001488613 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 271316416 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 150 SECOND STREET CITY: CAMBRIDGE STATE: MA ZIP: 02141 BUSINESS PHONE: 617-418-2200 MAIL ADDRESS: STREET 1: 150 SECOND STREET CITY: CAMBRIDGE STATE: MA ZIP: 02141 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KPCB XIV Associates, LLC CENTRAL INDEX KEY: 0001546196 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36086 FILM NUMBER: 14892221 BUSINESS ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650.233.2750 MAIL ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KPCB XIV Founders Fund, LLC CENTRAL INDEX KEY: 0001546197 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36086 FILM NUMBER: 14892222 BUSINESS ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650.233.2750 MAIL ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kleiner Perkins Caufield & Byers XIV, LLC CENTRAL INDEX KEY: 0001505781 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36086 FILM NUMBER: 14892223 BUSINESS ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-233-2750 MAIL ADDRESS: STREET 1: 2750 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 4 1 rrd411052.xml DISTRIBUTION X0306 4 2014-06-03 0 0001488613 Foundation Medicine, Inc. FMI 0001505781 Kleiner Perkins Caufield & Byers XIV, LLC 2750 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001546197 KPCB XIV Founders Fund, LLC 2750 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001546196 KPCB XIV Associates, LLC 2750 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 Common Stock 2014-06-03 4 J 0 322700 0 D 2602637 D Common Stock 2014-06-03 4 J 0 27300 0 D 220180 D Common Stock 2014-06-03 4 J 0 52997 0 A 52997 D Common Stock 2014-06-03 4 J 0 52997 0 D 0 D Kleiner Perkins Caufield & Byers XIV, LLC ("KPCB XIV") made pro rata distributions for no consideration to its members of 322,700 shares of common stock of the issuer on June 3, 2014 (the "Fund Distribution"). The shares are directly held by KPCB XIV. All shares are held for convenience in the name of "KPCB Holdings, Inc., as nominee". The managing member of KPCB XIV is KPCB XIV Associates, LLC ("XIV Associates"). The voting and dispositive control over the shares is shared by individual managing members of XIV Associates, none of whom has veto power. KPCB XIV Founders Fund, LLC ("KPCB XIV FF") made pro rata distributions for no consideration to its members of 27,300 shares of common stock of the issuer on June 3, 2014. The shares are directly held by XIV Associates. All shares are held for convenience in the name of "KPCB Holdings, Inc., as nominee". The voting and dispositive control over the shares is shared by individual managing members of XIV Associates, none of whom has veto power. Shares acquired in connection with the Fund Distribution of such shares to the members of KPCB XIV. Shares are owned directly by XIV Associates and the individual managing directors may be deemed to have shared voting and dispositive power over the shares owned by XIV Associates. XIV Associates made pro rata distributions for no consideration to its members of 52,997 shares of common stock of the issuer on June 3, 2014. The reporting persons disclaim beneficial ownership of these shares except to the extent of any pecuniary interest therein, and the filing of this report is not an admission that the reporting persons are the beneficial owners of these shares for purposes of Section 16 or for any other purpose. /s/ Paul Vronsky as Attorney-In-Fact for Kleiner Perkins Caufield & Byers XIV, LLC 2014-06-04 /s/ Paul Vronsky as Attorney-In-Fact for KPCB XIV Founders Fund, LLC 2014-06-04 /s/ Paul Vronsky as Attorney-In-Fact for KPCB XIV Associates, LLC 2014-06-04