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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/10/2024 |
3. Issuer Name and Ticker or Trading Symbol
Camp4 Therapeutics Corp [ CAMP ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Series A Prime Preferred Stock | (1) | (1) | Common Stock | 1,337,513 | (1) | I | By AH Bio Fund I, L.P., as nominee(2) |
Series B Preferred Stock | (1) | (1) | Common Stock | 60,554 | (1) | I | By AH Bio Fund I, L.P., as nominee(2) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. Each share of Series A Prime Preferred Stock and Series B Preferred Stock (collectively, the "Preferred Stock") is convertible into shares of Common Stock of the Issuer on a 11.2158-for-one basis without payment of further consideration. Upon the closing of the Issuer's initial public offering, the Preferred Stock will convert into the number of shares of Common Stock of the Issuer shown in column 3. The Preferred Stock has no expiration date. |
2. These shares are held of record by AH Bio Fund I, L.P. ("AH Bio I") for itself and as nominee for AH Bio Fund I-B, L.P. (collectively, the "AH Bio I Entities"). AH Equity Partners Bio I, L.L.C. ("AH EP Bio I"), the general partner of the AH Bio I Entities, may be deemed to have sole power to vote and to dispose of these shares, and Marc Andreessen and Benjamin Horowitz, the managing members of AH EP Bio I, may be deemed to have shared power to vote and to dispose of these shares. Each of the Reporting Persons disclaims the existence of a "group" and disclaims beneficial ownership of the securities held of record by AH Bio I and this report shall not be deemed an admission that any such person is the beneficial owner of such securities, except to the extent of such person's pecuniary interest therein, if any. |
AH Bio Fund I, L.P. for itself and as nominee for AH Bio Fund I-B, L.P., By: AH Equity Partners Bio I, L.L.C., its General Partner, By /s/ Scott Kupor, Authorized Signatory | 10/10/2024 | |
AH Equity Partners Bio I, L.L.C.: By /s/ Scott Kupor, Authorized Signatory | 10/10/2024 | |
/s/ Scott Kupor, Attorney-in-Fact for Marc Andreessen | 10/10/2024 | |
/s/ Scott Kupor, Attorney-in-Fact for Benjamin Horowitz | 10/10/2024 | |
** 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. |