SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
AFEYAN NOUBAR

(Last) (First) (Middle)
C/O ELEVEN BIOTHERAPEUTICS, INC.
215 FIRST STREET, SUITE 400

(Street)
CAMBRIDGE MA 02142

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/05/2014
3. Issuer Name and Ticker or Trading Symbol
Eleven Biotherapeutics, Inc. [ EBIO ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
No securities are beneficially owned 0(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. Mr. Afeyan does not own shares in his individual capacity. He is a manager of Flagship Ventures 2007 General Partner LLC ("Fund 2007 GP"), the sole general partner of Flagship Ventures Fund 2007, L.P. ("Flagship 2007"), and a manager of Flagship Ventures Fund IV General Partner LLC ("Fund IV GP"), the sole general partner of each of Flagship Ventures Fund IV, L.P. ("Flagship IV"), and Flagship Ventures Fund IV-Rx, L.P ("Flagship IV-Rx"). Flagship 2007, Flagship IV and Flagship IV-Rx (collectively, the "Funds") are reporting persons and, concurrently herewith, are jointly filing a Form 3 reporting their ownership in certain of the Issuer's derivative and non-derivative securities (collectively, the "Fund Shares"). As a manager of Fund 2007 GP and Fund IV GP, Mr. Afeyan may be deemed to share voting and investment power with respect to the Fund Shares. Mr. Afeyan disclaims beneficial ownership of the Fund Shares, except to the extent of his pecuniary interest therein.
/s/ Noubar B. Afeyan, Ph.D. 02/05/2014
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: 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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