Initial Statement of Beneficial Ownership (3)
September 28 2016 - 4:15PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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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1. Name and Address of Reporting Person
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Clairmark Investments Ltd.
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2. Date of Event Requiring Statement (MM/DD/YYYY)
9/20/2016
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3. Issuer Name
and
Ticker or Trading Symbol
Eleven Biotherapeutics, Inc. [EBIO]
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(Last)
(First)
(Middle)
C/O ELEVEN BIOTHERAPEUTICS, INC., 215 FIRST STREET, SUITE 400
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
___
X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
CAMBRIDGE, MA 02142
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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3582328
(1)
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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The reporting person acquired 3,582,328 shares of issuer common stock in exchange for an 89.2585% interest in Viventia Bio, Inc. pursuant to the issuer's purchase of all outstanding capital stock of Viventia Bio Inc. on September 20, 2016. Of the 3,582,328 shares issued to the reporting person in the transaction 358,232 shares re currently being held in escrow and are subject to forfeiture during the 15-month period following the transaction to satisfy claims arising as a result of Viventia Bio Inc.'s or the reporting person's breach of any of their respective representations, warranties or covenants in the share purchase agreement.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Clairmark Investments Ltd.
C/O ELEVEN BIOTHERAPEUTICS, INC.
215 FIRST STREET, SUITE 400
CAMBRIDGE, MA 02142
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X
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Signatures
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CLAIRMARK INVESTMENTS LTD. /s/ Leslie L. Dan, President
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9/22/2016
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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