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