Form D Raw Data - Electronic Filing Depository

EFDID: 307021EFD: Raw Data

Issuer: Bourne Seniors Housing V, LLC (0001766259) - D

Accession: 0001766259-19-000001 () (EDGAR Files) (Form D)

Edgar Posted: Mar. 13, 2019
EFD Posted: Mar. 14, 2019

- < edgarSubmission >

< schemaVersion > X0708 </ schemaVersion >

< submissionType > D </ submissionType >

< testOrLive > LIVE </ testOrLive >

- < primaryIssuer >

< cik > 0001766259 </ cik >

< entityName > Bourne Seniors Housing V, LLC </ entityName >

- < issuerAddress >

< street1 > 228 N. PARK AVENUE, SUITE A </ street1 >

< city > WINTER PARK </ city >

< stateOrCountry > FL </ stateOrCountry >

< stateOrCountryDescription > FLORIDA </ stateOrCountryDescription >

< zipCode > 32789 </ zipCode >

</ issuerAddress >

< issuerPhoneNumber > (407) 644-6444 </ issuerPhoneNumber >

< jurisdictionOfInc > DELAWARE </ jurisdictionOfInc >

- < issuerPreviousNameList >

< value > None </ value >

</ issuerPreviousNameList >

- < edgarPreviousNameList >

< value > None </ value >

</ edgarPreviousNameList >

< entityType > Limited Liability Company </ entityType >

- < yearOfInc >

< withinFiveYears > true </ withinFiveYears >

< value > 2018 </ value >

</ yearOfInc >

</ primaryIssuer >

- < relatedPersonsList >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Robert </ firstName >

< middleName > A. </ middleName >

< lastName > Bourne </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 228 N. Park Avenue, Suite A </ street1 >

< city > Winter Park </ city >

< stateOrCountry > FL </ stateOrCountry >

< stateOrCountryDescription > FLORIDA </ stateOrCountryDescription >

< zipCode > 32789 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > R. </ firstName >

< middleName > Kyle </ middleName >

< lastName > Bourne </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 228 N. Park Avenue, Suite A </ street1 >

< city > Winter Park </ city >

< stateOrCountry > FL </ stateOrCountry >

< stateOrCountryDescription > FLORIDA </ stateOrCountryDescription >

< zipCode > 32789 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Michael </ firstName >

< middleName > C. </ middleName >

< lastName > Kelley </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 228 N. Park Avenue, Suite A </ street1 >

< city > Winter Park </ city >

< stateOrCountry > FL </ stateOrCountry >

< stateOrCountryDescription > FLORIDA </ stateOrCountryDescription >

< zipCode > 32789 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Samuel </ firstName >

< lastName > Spears </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 228 N. Park Avenue, Suite A </ street1 >

< city > Winter Park </ city >

< stateOrCountry > FL </ stateOrCountry >

< stateOrCountryDescription > FLORIDA </ stateOrCountryDescription >

< zipCode > 32789 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Bourne Seniors Housing Manager V, LLC </ firstName >

< lastName > Bourne Seniors Housing Manager V, LLC </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 228 N. Park Avenue, Suite A </ street1 >

< city > Winter Park </ city >

< stateOrCountry > FL </ stateOrCountry >

< stateOrCountryDescription > FLORIDA </ stateOrCountryDescription >

< zipCode > 32789 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Promoter </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Bourne Financial Group, LLC </ firstName >

< lastName > Bourne Financial Group, LLC </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > 228 N. Park Avenue, Suite A </ street1 >

< city > Winter Park </ city >

< stateOrCountry > FL </ stateOrCountry >

< stateOrCountryDescription > FLORIDA </ stateOrCountryDescription >

< zipCode > 32789 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Promoter </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

</ relatedPersonsList >

- < offeringData >

- < industryGroup >

< industryGroupType > Other Real Estate </ industryGroupType >

</ industryGroup >

- < issuerSize >

< revenueRange > Decline to Disclose </ revenueRange >

</ issuerSize >

- < federalExemptionsExclusions >

< item > 06b </ item >

</ federalExemptionsExclusions >

- < typeOfFiling >

- < newOrAmendment >

< isAmendment > false </ isAmendment >

</ newOrAmendment >

- < dateOfFirstSale >

< yetToOccur > true </ yetToOccur >

</ dateOfFirstSale >

</ typeOfFiling >

- < durationOfOffering >

< moreThanOneYear > false </ moreThanOneYear >

</ durationOfOffering >

- < typesOfSecuritiesOffered >

< isEquityType > true </ isEquityType >

</ typesOfSecuritiesOffered >

- < businessCombinationTransaction >

< isBusinessCombinationTransaction > false </ isBusinessCombinationTransaction >

< clarificationOfResponse />

</ businessCombinationTransaction >

< minimumInvestmentAccepted > 25000 </ minimumInvestmentAccepted >

- < salesCompensationList >

- < recipient >

< recipientName > Cobalt Capital, Inc. </ recipientName >

< recipientCRDNumber > 136161 </ recipientCRDNumber >

< associatedBDName > None </ associatedBDName >

< associatedBDCRDNumber > None </ associatedBDCRDNumber >

- < recipientAddress >

< street1 > 11650 S. State Street </ street1 >

< city > Draper </ city >

< stateOrCountry > UT </ stateOrCountry >

< stateOrCountryDescription > UTAH </ stateOrCountryDescription >

< zipCode > 84020 </ zipCode >

</ recipientAddress >

- < statesOfSolicitationList >

< state > CA </ state >

< description > CALIFORNIA </ description >

< state > CO </ state >

< description > COLORADO </ description >

< state > FL </ state >

< description > FLORIDA </ description >

< state > ID </ state >

< description > IDAHO </ description >

< state > MA </ state >

< description > MASSACHUSETTS </ description >

< state > NM </ state >

< description > NEW MEXICO </ description >

< state > NY </ state >

< description > NEW YORK </ description >

< state > NC </ state >

< description > NORTH CAROLINA </ description >

< state > TX </ state >

< description > TEXAS </ description >

< state > UT </ state >

< description > UTAH </ description >

</ statesOfSolicitationList >

< foreignSolicitation > false </ foreignSolicitation >

</ recipient >

</ salesCompensationList >

- < offeringSalesAmounts >

< totalOfferingAmount > 75000000 </ totalOfferingAmount >

< totalAmountSold > 0 </ totalAmountSold >

< totalRemaining > 75000000 </ totalRemaining >

< clarificationOfResponse />

</ offeringSalesAmounts >

- < investors >

< hasNonAccreditedInvestors > false </ hasNonAccreditedInvestors >

< totalNumberAlreadyInvested > 0 </ totalNumberAlreadyInvested >

</ investors >

- < salesCommissionsFindersFees >

- < salesCommissions >

< dollarAmount > 7500000 </ dollarAmount >

< isEstimate > true </ isEstimate >

</ salesCommissions >

- < findersFees >

< dollarAmount > 0 </ dollarAmount >

</ findersFees >

< clarificationOfResponse />

</ salesCommissionsFindersFees >

- < useOfProceeds >

- < grossProceedsUsed >

< dollarAmount > 1125000 </ dollarAmount >

< isEstimate > true </ isEstimate >

</ grossProceedsUsed >

< clarificationOfResponse > The Manager will receive acquisition fees equal to 1.5% of the acquisition and development costs of the Company's real estate assets. The total amount paid will depend on the actual amount of such costs. </ clarificationOfResponse >

</ useOfProceeds >

- < signatureBlock >

< authorizedRepresentative > false </ authorizedRepresentative >

- < signature >

< issuerName > Bourne Seniors Housing V, LLC </ issuerName >

< signatureName > /s/ Robert A. Bourne </ signatureName >

< nameOfSigner > Robert A. Bourne </ nameOfSigner >

< signatureTitle > CEO of the Sole Member of the Issuer's Manager </ signatureTitle >

< signatureDate > 2019-03-13 </ signatureDate >

</ signature >

</ signatureBlock >

</ offeringData >

</ edgarSubmission >