SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
NeoMed Innovation V L.P.

(Last) (First) (Middle)
13 CASTLE STREET

(Street)
ST HELIER Y9 JE4 5UT

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Arsanis, Inc. [ ASNS ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
11/20/2017
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 11/20/2017 C 246,682 A (1) 246,682 D(4)
Common Stock 11/20/2017 C 41,878 A (2) 288,560 D(4)
Common Stock 11/20/2017 C 279,079 A (3) 567,639 D(4)
Common Stock 11/20/2017 P 300,000 A $10 867,639 D(4)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series B Convertible Preferred Stock (1) 11/20/2017 C 552,487 (1) (1) Common Stock 246,682 $0.00 0 D(4)
Series C Convertible Preferred Stock (2) 11/20/2017 C 84,040 (2) (2) Common Stock 41,878 $0.00 0 D(4)
Series D Convertible Preferred Stock (3) 11/20/2017 C 952,497 (3) (3) Common Stock 279,079 $0.00 0 D(4)
1. Name and Address of Reporting Person*
NeoMed Innovation V L.P.

(Last) (First) (Middle)
13 CASTLE STREET

(Street)
ST HELIER Y9 JE4 5UT

(City) (State) (Zip)
1. Name and Address of Reporting Person*
NeoMed Management (Jersey) Ltd

(Last) (First) (Middle)
13 CASTLE STREET

(Street)
ST HELIER Y9

(City) (State) (Zip)
1. Name and Address of Reporting Person*
NeoMed Innovation V Ltd

(Last) (First) (Middle)
13 CASTLE STREET

(Street)
ST HELIER Y9

(City) (State) (Zip)
Explanation of Responses:
1. The Series B Convertible Preferred Stock converted into Common Stock on a 0.44650-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series B Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date.
2. The Series C Convertible Preferred Stock converted into Common Stock on a 0.49832-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series C Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date.
3. The Series D Convertible Preferred Stock converted into Common Stock on a 0.29300-for-one basis upon the closing of the Issuer's initial public offering without payment of consideration. The Series D Convertible Preferred Stock was convertible at any time at the holder's election and automatically upon the closing at the Issuer's initial public offering. The shares had no expiration date.
4. The reported securities are held of record by NeoMed Innovation V L.P. NeoMed Management (Jersey) Limited is the Investment Manager to NeoMed Innovation V L.P. NeoMed Innovation V Limited is the general partner of Neomed Innovation V L.P. By virtue of such relationships, NeoMed Management (Jersey) Limited and NeoMed Innovation V Limited may be deemed to have voting and investment power with respect to the shares held by NeoMed Innovation V L.P. Each of NeoMed Management (Jersey) Limited and NeoMed Innovation V Limited disclaims beneficial ownership of the shares held by NeoMed Innovation V L.P., except to the extent of its or his pecuniary interest therein, if any.
Remarks:
/s/ Mike Gray, as attorney-in-fact on behalf of NeoMed Innovation V L.P. 11/20/2017
/s/ Mike Gray, as attorney-in-fact on behalf of NeoMed Management (Jersey) Limited 11/20/2017
/s/ Mike Gray, as attorney-in-fact on behalf of NeoMed Innovation V Limited 11/20/2017
** Signature of Reporting Person Date
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