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*
Peterson Caryn

(Last) (First) (Middle)
3013 SCIENCE PARK ROAD

(Street)
SAN DIEGO CA 92121

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/16/2021
3. Issuer Name and Ticker or Trading Symbol
Gossamer Bio, Inc. [ GOSS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP, Regulatory Affairs
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)
Common Stock 64,008(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
Stock Option (Right to Buy) (2) 05/21/2028 Common Stock 86,444 $2.61 D
Stock Option (Right to Buy) (3) 12/10/2028 Common Stock 48,888 $10.71 D
Stock Option (Right to Buy) (4) 03/25/2029 Common Stock 48,500 $22.1 D
Stock Option (Right to Buy) (5) 12/23/2029 Common Stock 13,750 $16.4 D
Stock Option (Right to Buy) (6) 02/14/2030 Common Stock 34,175 $14.55 D
Stock Option (Right to Buy) (7) 02/25/2031 Common Stock 28,250 $9.79 D
Explanation of Responses:
1. Includes 54,427 restricted stock unit awards, which will vest in accordance with the terms of each award and subject to the Reporting Person's continuous service to the Issuer on each vesting date.
2. 64,840 shares subject to the option have vested and are fully exerciseable and 1/48th of the total number of shares subject to the option vest on April 21, 2021 and the last day of each one-month period thereafter through May 21, 2022, subject to the Reporting Person's continuous service to the Issuer on each such vesting date.
3. 28,540 shares subject to the option have vested and are fully exerciseable and 1/48th of the total number of shares subject to the option vest on May 10, 2021 and the last day of each one-month period thereafter through December 10, 2022, subject to the Reporting Person's continuous service to the Issuer on each such vesting date.
4. 24,250 shares subject to the option have vested and are fully exerciseable and 1/48th of the total number of shares subject to the option vest on April 25, 2021 and the last day of each one-month period thereafter through March 25, 2023, subject to the Reporting Person's continuous service to the Issuer on each such vesting date.
5. 4,296 shares subject to the option have vested and are fully exerciseable and 1/48th of the total number of shares subject to the option vest on April 23, 2021 and the last day of each one-month period thereafter through December 23, 2023, subject to the Reporting Person's continuous service to the Issuer on each such vesting date.
6. 9,967 shares subject to the option have vested and are fully exerciseable and 1/48th of the total number of shares subject to the option vest on May 14, 2021 and the last day of each one-month period thereafter through February 14, 2024, subject to the Reporting Person's continuous service to the Issuer on each such vesting date.
7. 25% of the total number of shares subject to the option will vest on February 25, 2022 and 1/48th of the total number of shares subject to the option vest on the last day of each one-month period thereafter, subject to the Reporting Person's continuous service to the Issuer on each such vesting date.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Jeff Boerneke, Attorney-in-Fact 04/20/2021
** 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.
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 Number.