SEC FORM
3
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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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
888 BOYLSTON STREET, SUITE 1111 |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 11/02/2023
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3. Issuer Name and Ticker or Trading Symbol
Lexeo Therapeutics, Inc.
[ LXEO ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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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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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Series A convertible preferred stock |
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Common Stock |
1,415,865 |
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D
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Series B convertible preferred stock |
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Common Stock |
246,883
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D
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1. Name and Address of Reporting Person*
888 BOYLSTON STREET, SUITE 1111 |
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(Street)
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1. Name and Address of Reporting Person*
888 BOYLSTON STREET, SUITE 1111 |
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(Street)
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1. Name and Address of Reporting Person*
888 BOYLSTON STREET, SUITE 1111 |
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(Street)
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1. Name and Address of Reporting Person*
C/O OMEGA FUNDS |
888 BOYLSTON ST., SUITE 1111 |
(Street)
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1. Name and Address of Reporting Person*
C/O OMEGA FUNDS |
888 BOYLSTON STREET, SUITE 1111 |
(Street)
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1. Name and Address of Reporting Person*
C/O OMEGA FUNDS |
888 BOYLSTON STREET, SUITE 1111 |
(Street)
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Explanation of Responses: |
Remarks: |
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/s/ Otello Stampacchia, authorized signatory |
11/02/2023 |
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/s/ Otello Stampacchia, authorized signatory |
11/02/2023 |
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/s/ Otello Stampacchia, authorized signatory |
11/02/2023 |
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/s/ Otello Stampacchia, authorized signatory |
11/02/2023 |
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/s/ Otello Stampacchia, authorized signatory |
11/02/2023 |
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/s/ Otello Stampacchia, authorized signatory |
11/02/2023 |
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** 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. |
Exhibit 24
POWER OF ATTORNEY
Know all by these presents, that each of the undersigned hereby constitutes and
appoints each other undersigned, such person's true and lawful attorney-in-fact,
to:
(1) execute for and on behalf of each of such person Forms 3, 4, and 5 and
Schedules 13D or 13G, as appropriate, and any required amendments thereto
(collectively, the "Reports"), with respect to their current or future
beneficial ownership of securities of any public company, in accordance with
Section 13(d) and/or Section 16(a) of the Securities Exchange Act of 1934, as
amended, and the respective rules (including Rule 13 d-1) promulgated
thereunder;
(2) do and perform any and all acts for and on behalf of such person which may
be necessary or desirable to complete and execute any such Report and timely
file such form with the United States Securities and Exchange Commission and any
stock exchange or similar authority; and
(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of an attorney-in-fact, may be of benefit to, in
the best interest of, or legally required by, such person, it being understood
that the documents executed by an attorney-in-fact on behalf of such person
pursuant to this Power of Attorney shall be in such form and shall contain such
terms and conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
Each of the undersigned hereby grants to each attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that each attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this power of attorney and the rights and powers herein
granted. Each of the undersigned hereby ratifies and confirms each Report that
has been signed by any other undersigned prior to the date hereof. Each of the
undersigned acknowledges that each foregoing attorney-in-fact, in serving in
such capacity at the request of the undersigned, is not assuming any of the
undersigneds' responsibilities to comply with Section 13(d) or Section 16 of the
Securities Exchange Act of 1934.
This Power of Attorney shall remain in full force and effect until the
undersigned are no longer required to file Reports with respect to the
undersigneds' current or future holdings of and transactions in securities
issued by any public company, unless earlier revoked by the undersigned in a
signed writing delivered to each foregoing attorney-in-fact.
[The remainder of this page is intentionally left blank.]
IN WITNESS WHEREOF, the undersigned have caused this Power of Attorney to be
executed as of dates set forth opposite their names.
Dated: 11/2/2023 /s/ Otello Stampacchia
Otello Stampacchia
Dated: 2/11/2020 /s/ Claudio Nessi
Claudio Nessi
Dated: 2/11/2020 /s/ Anne-Mari Paster
Anne-Mari Paster
Dated: 2/11/2020 /s/ Deirdre A. Cunnane
Deirdre A. Cunnane