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