SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Flagship Pioneering Inc.

(Last) (First) (Middle)
55 CAMBRIDGE PARKWAY, SUITE 800

(Street)
CAMBRIDGE MA 02142

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Omega Therapeutics, Inc. [ OMGA ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
08/03/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 08/03/2021 C 1,088,470 A (1) 1,088,470 I See Footnotes(2)(9)(10)(11)
Common Stock 08/03/2021 C 5,896,386 A (1) 5,896,386 I See Footnotes(3)(9)(10)(11)
Common Stock 08/03/2021 C 8,396,825 A (1) 8,396,825 I See Footnotes(4)(9)(10)(11)
Common Stock 08/03/2021 P 220,588 A $17 8,617,413 I See Footnotes(4)(9)(10)(11)
Common Stock 08/03/2021 C 970,588 A (1) 970,588 I See Footnotes(5)(9)(10)(11)
Common Stock 08/03/2021 C 4,852,943 A (1) 4,852,943 I See Footnotes(6)(9)(10)(11)
Common Stock 08/03/2021 P 661,764 A $17 5,514,707 I See Footnotes(6)(9)(10)(11)
Common Stock 08/03/2021 C 1,323,529 A (1) 1,323,529 I See Footnotes(7)(9)(10)(11)
Common Stock 08/03/2021 P 294,117 A $17 1,617,646 I See Footnotes(7)(9)(10)(11)
Common Stock 2,197,059 I See Footnotes(8)(9)(10)(11)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series A Convertible Preferred Stock (1) 08/03/2021 C 4,112,000 (1) (1) Common Stock 1,088,470 (1) 0 I See Footnotes(2)(9)(10)(11)
Series A Convertible Preferred Stock (1) 08/03/2021 C 22,275,232 (1) (1) Common Stock 5,896,386 (1) 0 I See Footnotes(3)(9)(10)(11)
Series A Convertible Preferred Stock (1) 08/03/2021 C 27,388,000 (1) (1) Common Stock 7,249,767 (1) 0 I See Footnotes(4)(9)(10)(11)
Series A Convertible Preferred Stock (1) 08/03/2021 C 3,000,000 (1) (1) Common Stock 794,118 (1) 0 I See Footnotes(5)(9)(10)(11)
Series B Convertible Preferred Stock (1) 08/03/2021 C 2,666,667 (1) (1) Common Stock 705,882 (1) 0 I See Footnotes(4)(9)(10)(11)
Series B Convertible Preferred Stock (1) 08/03/2021 C 666,667 (1) (1) Common Stock 176,470 (1) 0 I See Footnotes(5)(9)(10)(11)
Series B Convertible Preferred Stock (1) 08/03/2021 C 13,333,333 (1) (1) Common Stock 3,529,413 (1) 0 I See Footnotes(6)(9)(10)(11)
Series B Convertible Preferred Stock (1) 08/03/2021 C 3,333,333 (1) (1) Common Stock 882,353 (1) 0 I See Footnotes(7)(9)(10)(11)
Series C Convertible Preferred Stock (1) 08/03/2021 C 1,666,667 (1) (1) Common Stock 441,176 (1) 0 I See Footnotes(4)(9)(10)(11)
Series C Convertible Preferred Stock (1) 08/03/2021 C 5,000,000 (1) (1) Common Stock 1,323,530 (1) 0 I See Footnotes(6)(9)(10)(11)
Series C Convertible Preferred Stock (1) 08/03/2021 C 1,666,666 (1) (1) Common Stock 441,176 (1) 0 I See Footnotes(7)(9)(10)(11)
1. Name and Address of Reporting Person*
Flagship Pioneering Inc.

(Last) (First) (Middle)
55 CAMBRIDGE PARKWAY, SUITE 800

(Street)
CAMBRIDGE MA 02142

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Flagship Ventures Fund V General Partner LLC

(Last) (First) (Middle)
55 CAMBRIDGE PARKWAY, SUITE 800E

(Street)
CAMBRIDGE MA 02142

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Flagship V VentureLabs Rx Fund, L.P.

(Last) (First) (Middle)
55 CAMBRIDGE PARKWAY, SUITE 800

(Street)
CAMBRIDGE MA 02142

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Flagship Ventures Fund V, L.P.

(Last) (First) (Middle)
55 CAMBRIDGE PARKWAY, SUITE 800

(Street)
CAMBRIDGE MA 02142

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Flagship VentureLabs V Manager LLC

(Last) (First) (Middle)
55 CAMBRIDGE PARKWAY, SUITE 800

(Street)
CAMBRIDGE MA 02142

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Flagship VentureLabs V LLC

(Last) (First) (Middle)
55 CAMBRIDGE PARKWAY, SUITE 800

(Street)
CAMBRIDGE MA 02142

(City) (State) (Zip)
Explanation of Responses:
1. The shares of Issuer's preferred stock have no expiration date and are convertible at the holder's election into Issuer's common stock at a conversion ratio of 1-to-0.264706. The preferred stock will automatically convert into shares of the Issuer's common stock, for no additional consideration, upon the closing of the Issuer's initial public offering.
2. Represents shares held directly by Flagship V VentureLabs Rx Fund, L.P. ("Flagship Fund V Rx").
3. Represents shares held directly by Flagship Ventures Fund V, L.P. ("Flagship Fund V").
4. Represents shares held directly by Flagship Pioneering Fund VI, L.P. ("Flagship Pioneering VI").
5. Represents shares held directly by Nutritional Health LTP Fund, L.P. ("Nutritional LTP").
6. Represents shares held directly by Flagship Pioneering Special Opportunities Fund II, L.P. ("Flagship Opportunities Fund II")
7. Represents shares held directly by FPN, L.P. ("FPN Fund").
8. Represents shares held directly by Flagship VentureLabs V, LLC ("VentureLabs V").
9. Flagship Fund V is a member of VentureLabs V. VentureLabs V Manager LLC ("VentureLabs V Manager") is the manager of VentureLabs V. Flagship Pioneering, Inc. ("Flagship Pioneering") is the manager of VentureLabs V Manager. The General Partner of Flagship Fund V and Flagship Fund V Rx is Flagship Ventures Fund V General Partner LLC ("Flagship V GP"). The General Partner of Flagship Pioneering VI is Flagship Pioneering Fund VI General Partner LLC ("Flagship Pioneering VI GP"). The General Partner of Flagship Opportunities Fund II is Flagship Pioneering Special Opportunities Fund II General Partner LLC ("Flagship Opportunities Fund II GP").
10. (continued from above) The general partner of FPN Fund is FPN General Partner LLC ("FPN GP"). The manager of Flagship Pioneering VI GP, Flagship Opportunities Fund II GP, and FPN GP is Flagship Pioneering. The general partner of Nutritional LTP is Nutritional Health LTP Fund General Partner LLC ("Nutritional LTP GP" and, together with VentureLabs V Manager, Flagship Pioneering, Flagship V GP, Flagship Pioneering VI GP, Flagship Opportunities Fund II GP and FPN GP, the "Flagship General Partners").
11. (continued from above) Noubar B. Afeyan, Ph.D. ("Dr. Afeyan") is the sole director of Flagship Pioneering and may be deemed to have beneficial ownership of all the shares held by VentureLabs V, Flagship Pioneering VI, Flagship Opportunities Fund II and FPN Fund. In addition, Dr. Afeyan serves as the sole manager of Flagship V GP and is the sole member and manager of Nutritional LTP GP and may be deemed to have beneficial ownership of all the shares held by Flagship Fund V, Flagship Fund V Rx and Nutritional LTP. None of the Flagship General Partners nor Dr. Afeyan directly own any of the shares held by the Reporting Persons, and each of the Flagship General Partners and Dr. Afeyan disclaims beneficial ownership of such shares except to the extent of its or his pecuniary interest therein.
Remarks:
Due to the limitations of the electronic filing system, each of Flagship Pioneering Fund VI General Partner LLC, Flagship Pioneering Fund VI, L.P., Flagship Pioneering Special Opportunities Fund II, L.P., Flagship Pioneering Special Opportunities Fund II General Partner LLC, Nutritional Health LTP Fund, L.P., Nutritional Health LTP Fund General Partner LLC, FPN General Partner LLC, FPN, L.P. and Noubar Afeyan are filing a separate Form 4. Each Form 4 will be filed by Designated Filer Flagship Pioneering, Inc.
Flagship Ventures Fund V General Partner LLC, By: /s/ Noubar B. Afeyan, Ph.D., Manager 08/05/2021
Flagship V VentureLabs Rx Fund, L.P., By: Flagship Ventures Fund V General Partner LLC, its General Partner, By: /s/ Noubar B. Afeyan, Ph.D., Manager 08/05/2021
Flagship Ventures Fund V, L.P., By: Flagship Ventures Fund V General Partner LLC, its General Partner, By: /s/ Noubar B. Afeyan, Ph.D., Manager 08/05/2021
Flagship VentureLabs V Manager LLC, By: Flagship Pioneering, Inc., its Manager, By: /s/ Noubar B. Afeyan, Ph.D., Director 08/05/2021
Flagship VentureLabs V LLC., By: Flagship VentureLabs V Manager LLC, its Manager, By: Flagship Pioneering, Inc., its Manager, By: /s/ Noubar B. Afeyan, Ph.D., Director 08/05/2021
** 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 4 (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).
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