Ownership Submission
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FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549INITIAL 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
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OMB Number:3235-0104Expires:January 31, 2005Estimated average burden hours per response...0.5
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1. Name and Address of Reporting Person *
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Polaris Partners GP X, L.L.C.
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2. Date of Event Requiring Statement (Month/Day/Year)
2024-10-15
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3. Issuer Name and Ticker or Trading Symbol
Camp4 Therapeutics Corp [CAMP]
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(Last)
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(First)
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(Middle)
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ONE MARINA PARK DRIVE, 8TH FLOOR
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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_____ Director
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_____ 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 Original Filed(Month/Day/Year)
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6. Individual or Join/Group Filing(Check Applicable Line)
___ 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
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1.Title of Security
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2. Amount of Securities Beneficially Owned
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3. Ownership Form: Direct (D) or Indirect (I)
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4. Nature of Indirect Beneficial Ownership
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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 Derivate Security
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2. Date Exercisable and Expiration Date
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3. Title and Amount of Securities Underlying Derivative Security
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
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6. Nature of Indirect Beneficial Ownership
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Date Exercisable
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Expriation Date
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Title
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Amount or Number of Shares
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Polaris Partners GP X, L.L.C.
ONE MARINA PARK DRIVE, 8TH FLOOR
BOSTON, MA02210
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Polaris Partners X, L.P.
ONE MARINA PARK DRIVE, 8TH FLOOR
BOSTON, MA02210
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SCHULMAN AMY W
ONE MARINA PARK DRIVE, 8TH FLOOR
BOSTON, MA02210
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Signatures
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/s/ Lauren Crockett, as general counsel of Polaris Partners GP X, L.L.C., general partner of Polaris Partners X, L.P.
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2024-10-15
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**Signature of Reporting Person
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Date
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/s/ Lauren Crockett, as general counsel of Polaris Partners GP X, L.L.C.
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2024-10-15
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**Signature of Reporting Person
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Date
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/s/ Lauren Crockett, as attorney-in-fact for Brian Chee
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2024-10-15
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**Signature of Reporting Person
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Date
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/s/ Lauren Crockett, as attorney-in-fact for Amy Schulman
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2024-10-15
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**Signature of Reporting Person
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Date
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Explanation of Responses:
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(*)
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If the form is filed by more than one reporting person, see Instruction 5(b)(v).
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(**)
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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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(1)
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The reported securities are owned directly by Polaris Partners X, L.P. ("PP X"). Polaris Partners GP X, L.L.C. ("PPGP X") is the general partner of PP X. Each of Amy Schulman and Brian Chee are the managing members of PPGP X (the "Managing Members"). Amir Nashat ("Mr. Nashat"), a member of the Issuer's board of directors, is an interest holder of PPGP X. Each of PPGP X, the Managing Members and Mr. Nashat, in their respective capacities with respect to PPGP X, may be deemed to have shared voting, investment and dispositive power with respect to the securities held by PP X. Each of PPGP X, the Managing Members and Mr. Nashat disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any one of the Managing Members, Mr. Nashat or PPGP X is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their respective pecuniary interests therein.
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