0000899243-20-020237.txt : 20200723 0000899243-20-020237.hdr.sgml : 20200723 20200723170656 ACCESSION NUMBER: 0000899243-20-020237 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200723 FILED AS OF DATE: 20200723 DATE AS OF CHANGE: 20200723 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bain Capital Life Sciences Investors, LLC CENTRAL INDEX KEY: 0001703031 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39402 FILM NUMBER: 201044244 BUSINESS ADDRESS: STREET 1: 200 CLARENDON STREET CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 6175162878 MAIL ADDRESS: STREET 1: 200 CLARENDON STREET CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bain Capital Life Sciences Partners, LP CENTRAL INDEX KEY: 0001703030 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39402 FILM NUMBER: 201044245 BUSINESS ADDRESS: STREET 1: 200 CLARENDON STREET CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 6175162878 MAIL ADDRESS: STREET 1: 200 CLARENDON STREET CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bain Capital Life Sciences Fund, L.P. CENTRAL INDEX KEY: 0001687968 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39402 FILM NUMBER: 201044246 BUSINESS ADDRESS: STREET 1: 200 CLARENDON STREET CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 617-516-2000 MAIL ADDRESS: STREET 1: 200 CLARENDON STREET CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BCIP Life Sciences Associates, LP CENTRAL INDEX KEY: 0001702921 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39402 FILM NUMBER: 201044247 BUSINESS ADDRESS: STREET 1: 200 CLARENDON STREET CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 6175162878 MAIL ADDRESS: STREET 1: 200 CLARENDON STREET CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Koppel Adam CENTRAL INDEX KEY: 0001578965 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39402 FILM NUMBER: 201044248 MAIL ADDRESS: STREET 1: C/O BROOKSIDE CAPITAL, LLC STREET 2: JOHN HANCOCK TOWER, 200 CLARENDON ST CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Schwartz Jeffrey Lawrence CENTRAL INDEX KEY: 0001702957 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39402 FILM NUMBER: 201044249 MAIL ADDRESS: STREET 1: C/O BAIN CAPITAL LIFE SCIENCES, LP STREET 2: 200 CLARENDON STRERET CITY: BOSTON STATE: MA ZIP: 02116 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Annexon, Inc. CENTRAL INDEX KEY: 0001528115 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 275414423 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 180 KIMBALL WAY STREET 2: SUITE 200 CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 BUSINESS PHONE: (650)-822-5500 MAIL ADDRESS: STREET 1: 180 KIMBALL WAY STREET 2: SUITE 200 CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2020-07-23 0 0001528115 Annexon, Inc. ANNX 0001703031 Bain Capital Life Sciences Investors, LLC 200 CLARENDON STREET BOSTON MA 02116 0 0 1 0 0001703030 Bain Capital Life Sciences Partners, LP 200 CLARENDON STREET BOSTON MA 02116 0 0 1 0 0001687968 Bain Capital Life Sciences Fund, L.P. 200 CLARENDON STREET BOSTON MA 02116 0 0 1 0 0001702921 BCIP Life Sciences Associates, LP 200 CLARENDON STREET BOSTON MA 02116 0 0 1 0 0001578965 Koppel Adam C/O BAIN CAPITAL LIFE SCIENCES INVESTORS LLC, 200 CLARENDON STREET BOSTON MA 02116 0 0 1 0 0001702957 Schwartz Jeffrey Lawrence C/O BAIN CAPITAL LIFE SCIENCES INVESTORS LLC, 200 CLARENDON STREET BOSTON MA 02116 0 0 1 0 Series C Preferred Stock Common Stock 22222221 I See Footnotes Series D Preferred Stock Common Stock 2812543 I See Footnotes The shares of Series C Preferred Stock will automatically convert on a 1-for-8.81 basis into Common Stock immediately prior to the closing of the Issuer's initial public offering. The shares of Series D Preferred Stock will automatically convert on a 1-for-8.81 basis into Common Stock immediately prior to the closing of the Issuer's initial public offering. Represents 20,158,775 shares of Series C Preferred Stock held of record by Bain Capital Life Sciences Fund, L.P. ("BCLS") and 2,063,446 shares of Series C Preferred Stock held of record by BCIP Life Sciences Associates, LP ("BCIPLS" and, together with BCLS, the "Bain Capital Life Sciences Entities"). Represents 2,551,384 shares of Series D Preferred Stock held of record by BCLS and 261,159 shares of Series D Preferred Stock held of record by BCIPLS. Bain Capital Life Sciences Partners, LP ("BCLSP") is the general partner of BCLS. As a result, BCLSP may be deemed to share voting and dispositive power with respect to the securities held by BCLS. BCLSP disclaims beneficial ownership of such securities except to the extent of their pecuniary interest therein. Bain Capital Life Sciences Investors, LLC ("BCLSI"), whose managers are Jeffrey Schwartz and Adam Koppel, is the general partner of BCLSP and governs the investment strategy and decision-making process with respect to investments held by BCIPLS, whose general partner is Boylston Coinvestors, LLC. As a result, each of BCLSI, Mr. Schwartz and Dr. Koppel may be deemed to share voting and dispositive power over the shares held by the Bain Capital Life Sciences Entities. BCLSI, Mr. Schwartz and Dr. Koppel each disclaim beneficial ownership of such securities except to the extent of their pecuniary interest therein. BAIN CAPITAL LIFE SCIENCES INVESTORS, LLC, By: /s/ Jeffrey Schwartz, Name: Jeffrey Schwartz, Title: Managing Director 2020-07-23 BAIN CAPITAL LIFE SCIENCES PARTNERS, LP, By: Bain Capital Life Sciences Investors, LLC, its general partner, By: /s/ Jeffrey Schwartz, Name: Jeffrey Schwartz, Title: Managing Director 2020-07-23 BAIN CAPITAL LIFE SCIENCES FUND, L.P., By: Bain Capital Life Sciences Partners, LP, its general partner, By: Bain Capital Life Sciences Investors, LLC, its general partner, By: /s/ Jeffrey Schwartz, Name: Jeffrey Schwartz, Title: Managing Director 2020-07-23 BCIP LIFE SCIENCES ASSOCIATES, LP, By: Boylston Coinvestors, LLC, its general partner, By: /s/ Jeffrey Schwartz, Name: Jeffrey Schwartz, Title: Authorized Signatory 2020-07-23 /s/ Adam Koppel 2020-07-23 /s/ Jeffrey Schwartz 2020-07-23