0001209191-19-009410.txt : 20190212 0001209191-19-009410.hdr.sgml : 20190212 20190212172544 ACCESSION NUMBER: 0001209191-19-009410 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: Hasnain Faheem CENTRAL INDEX KEY: 0001352620 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38796 FILM NUMBER: 19592138 MAIL ADDRESS: STREET 1: 14 CAMBRIDGE CENTER CITY: CAMBRIDGE STATE: MA ZIP: 02142 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 0001352620 Hasnain Faheem 3013 SCIENCE PARK ROAD SAN DIEGO CA 92121 1 1 0 0 Executive Chairman Common Stock 2019-02-12 4 C 0 58599 A 3372109 I By family trust Series A Preferred Stock 2019-02-12 4 C 0 185984 D Common Stock 41329 0 I By family trust Series B Preferred Stock 2019-02-12 4 C 0 77719 D Common Stock 17270 0 I By family trust The shares of the Issuer's 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 A Preferred Stock and Series B Preferred Stock had no expiration date. Includes 2,595,584 shares subject to forfeiture, which shares will vest in equal monthly installments as set forth in the restricted stock agreements between the Issuer and Reporting Person so that all of the shares will be released from the forfeiture restriction on January 4, 2023, subject to the Reporting Person's continuous service to the Issuer on each such vesting date. The shares are also subject to certain accelerated vesting provisions as set forth in more detail in the employment agreement between the Issuer and the Reporting Person. /s/ Jeff Boerneke, Attorney-in-Fact 2019-02-12