0001209191-19-009463.txt : 20190212 0001209191-19-009463.hdr.sgml : 20190212 20190212174654 ACCESSION NUMBER: 0001209191-19-009463 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190212 FILED AS OF DATE: 20190212 DATE AS OF CHANGE: 20190212 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Omega Fund V, L.P. CENTRAL INDEX KEY: 0001641354 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38796 FILM NUMBER: 19592336 BUSINESS ADDRESS: STREET 1: 185 DARTMOUTH STREET CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 617-502-6538 MAIL ADDRESS: STREET 1: 185 DARTMOUTH STREET CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Omega Fund V GP, L.P. CENTRAL INDEX KEY: 0001641355 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38796 FILM NUMBER: 19592337 BUSINESS ADDRESS: STREET 1: 185 DARTMOUTH STREET CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 617-502-6538 MAIL ADDRESS: STREET 1: 185 DARTMOUTH STREET CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Omega Fund V GP Manager, Ltd. CENTRAL INDEX KEY: 0001641348 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38796 FILM NUMBER: 19592338 BUSINESS ADDRESS: STREET 1: 185 DARTMOUTH STREET CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 617-502-6538 MAIL ADDRESS: STREET 1: 185 DARTMOUTH STREET CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stampacchia Otello CENTRAL INDEX KEY: 0001361712 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38796 FILM NUMBER: 19592339 MAIL ADDRESS: STREET 1: 185 DARTMOUTH STREET CITY: BOSTON STATE: MA ZIP: 02116 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Gossamer Bio, Inc. CENTRAL INDEX KEY: 0001728117 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 475461709 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3013 SCIENCE PARK CITY: SAN DIEGO STATE: CA ZIP: 92121 BUSINESS PHONE: (858) 922-0718 MAIL ADDRESS: STREET 1: 3013 SCIENCE PARK CITY: SAN DIEGO STATE: CA ZIP: 92121 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-02-12 0 0001728117 Gossamer Bio, Inc. GOSS 0001641354 Omega Fund V, L.P. 185 DARTMOUTH STREET BOSTON MA 02116 0 0 1 0 0001641355 Omega Fund V GP, L.P. 185 DARTMOUTH STREET BOSTON MA 02116 0 0 1 0 0001641348 Omega Fund V GP Manager, Ltd. 185 DARTMOUTH STREET BOSTON MA 0 0 1 0 0001361712 Stampacchia Otello 185 DARTMOUTH STREET BOSTON MA 02116 1 0 1 0 Common Stock 2019-02-12 4 C 0 6953416 A 6953416 I See footnote Series Seed Preferred Stock 2019-02-12 4 C 0 20000000 D Common Stock 4444444 0 I See footnote Series A Preferred Stock 2019-02-12 4 C 0 7124620 D Common Stock 1583248 0 I See footnote Series B Preferred Stock 2019-02-12 4 C 0 4165760 D Common Stock 925724 0 I See footnote The shares of the Issuer's Series Seed Preferred Stock, Series A Preferred Stock and Series B Preferred Stock automatically converted into shares of the Issuer's Common Stock, for no additional consideration, at a ratio of 4.5 to one share, immediately prior to the consummation of the Issuer's initial public offering. The Series Seed Preferred Stock, Series A Preferred Stock and Series B Preferred Stock had no expiration date. The reported securities are held directly by Omega Fund V, L.P. ("Omega V"). The reported securities may be deemed to be beneficially owned by each of Omega Fund V GP, L.P. ("Omega V GP"), as the general partner of Omega V, and Omega Fund V GP Manager, Ltd. ("Omega V GP Manager"), as the general partner of Omega V GP. Otello Stampacchia, Richard Lim, Anne-Mari Paster and Claudio Nessi (the "Omega Directors") are all the shareholders and directors of Omega V GP Manager and have shared voting and investment power over the shares held by Omega V. Each of Omega V GP, Omega Fund V GP Manager and the Omega Directors disclaims beneficial ownership of the securities reported herein, except to the extent of its or their pecuniary interest therein, if any. /s/ Anne-Mari Paster, as an authorized signatory of each Reporting Person 2019-02-12