Vertical Builds: An Acquisition Strategy in the Altman Network

An educational overview of vertical integration as a corporate strategy — how companies acquire or partner with entities at every stage of a supply chain to control the full pipeline from raw material to end product — and how this strategy appears across the entities documented in this investigation.

What Is a Vertical Build?

A vertical build (or vertical integration) is a business strategy in which a company expands its operations into different stages of the same production pipeline. Instead of buying services from outside vendors at each stage, the company acquires or creates entities that handle each step internally. The result is a self-contained supply chain where value is captured at every stage rather than shared with independent providers.

This is not inherently nefarious. It is one of the oldest and most documented strategies in corporate history. Standard Oil vertically integrated oil extraction, refining, transportation, and retail. Carnegie Steel integrated mining, smelting, and manufacturing. Amazon integrated marketplace, logistics, cloud infrastructure, and delivery. In each case, the company that controls the full pipeline captures more value per unit than any competitor who relies on external vendors for parts of the chain.

When vertical integration becomes analytically significant in an investigation is when the integration is not visible to the public — when entities at different stages of the pipeline are presented as independent organizations but share common ownership, funding, or governance. The strategy itself is standard. The opacity is the concern.

Types of Vertical Integration

Type	Direction	Example
Backward integration	Acquiring suppliers (moving toward raw materials)	A drug company acquiring a clinical trial platform that recruits patients for its trials
Forward integration	Acquiring distributors or customers (moving toward end users)	A clinical trial platform acquiring the drugs it tests, then licensing them to pharma
Balanced integration	Acquiring in both directions simultaneously	A platform that sources patients (backward) AND acquires drugs AND licenses them to buyers (forward)

Formation Bio’s evolution represents balanced vertical integration: it moved backward (acquiring patient recruitment through 23andMe partnership and community physician network) and forward (acquiring drugs from other companies and licensing them to Sanofi for €545M) simultaneously, while controlling the middle (the clinical trial platform itself).

The Formation Bio Vertical

This is the most complete vertical build documented in this investigation. Each stage of the drug development pipeline is handled by an entity connected to the same network:

STAGE 1: PATIENT IDENTIFICATION
    │
    ├── 23andMe (genetic profiling → patient matching)
    │   └── Casdin Capital invested in BOTH 23andMe and TrialSpark
    │
    ├── Google Analytics methodology (Wesley Chan → FPV → Formation Bio)
    │   └── Data-driven patient targeting using behavioral analytics
    │
    └── Community physician network (TrialSpark's distributed trial site model)
        └── Local doctors become trial sites — patients recruited from existing practices
    
STAGE 2: SPECIMEN COLLECTION
    │
    ├── Speedy Sticks, LLC (mobile phlebotomy)
    │   └── Listed at Formation Bio's address (16 E 34th St)
    │   └── Related business: One Care Health, LLC (addiction treatment, Staten Island)
    │   └── Registered at 210 Catherine St (connected to Hardcore Tech address)
    │
    └── Clinical trial site blood draws, monitoring, and specimen processing
    
STAGE 3: CLINICAL TRIAL PLATFORM
    │
    ├── TrialSpark / Formation Bio (the platform itself)
    │   └── 16 E 34th St, Floor 10, NYC
    │   └── OpenResearch $1M nonprofit grant (FY2020)
    │   └── Project Covalence (COVID-era platform)
    │
    └── CRO services historically provided by Covance (LabCorp)
        └── Ken Somberg: Covance CMO → TrialSpark CMO (Nov 2019)
        └── TrialSpark replaced the need for an external CRO by becoming one
    
STAGE 4: DRUG ACQUISITION
    │
    ├── Libertas Bio → gusacitinib from Asana BioSciences (Nov 2022)
    ├── Riverview Bio → anti-CD226 from IMIDomics (Jul 2025)
    ├── High Line Bio → sprifermin from Merck KGaA
    ├── Bleecker Bio → LNK01006 from Lynk Pharmaceuticals (Dec 2025)
    │
    └── Each drug wrapped in a named subsidiary
        └── All subsidiaries at same address: 16 E 34th St, Floor 10
        └── Subsidiary created BEFORE drug acquired (Libertas Bio: Dec 2020 entity, Nov 2022 drug)
    
STAGE 5: AI-POWERED DEVELOPMENT
    │
    ├── Muse platform (Formation Bio + OpenAI + Sanofi, Nov 2024)
    │   └── AI accelerates trial design, patient matching, data analysis
    │   └── OpenAI provides the AI; Formation Bio provides the clinical data; Sanofi provides pharma expertise
    │
    └── Altman connection: OpenAI CEO + Formation Bio personal investor ($19M)
        └── Both sides of the AI-pharma partnership connected to same person
    
STAGE 6: DRUG LICENSING / SALE
    │
    ├── Sanofi licenses gusacitinib from Libertas Bio (Jun 2025, up to €545M)
    │   └── Sanofi was ALSO: commercial partner (Oct 2022), investor (Jun 2024), AI collaborator (Nov 2024)
    │   └── The buyer is also the investor is also the partner
    │
    └── Future: Riverview Bio, High Line Bio, Bleecker Bio drugs enter same pipeline
    
STAGE 7: REGULATORY / GOVERNMENT
    │
    ├── Scott Kupor: Formation Bio board → OPM Director (federal workforce management)
    ├── Sriram Krishnan: a16z partner → White House AI policy advisor
    ├── David Sacks: allied VC → White House AI/Crypto czar
    ├── David Friedberg: Google Analytics co-creator → PCAST (science advisory)
    │
    └── The people who governed or invested in the pipeline companies
        now govern the regulatory environment those companies operate in

The vertical is complete. From patient identification (23andMe genetic data) through specimen collection (Speedy Sticks phlebotomy) through clinical trials (TrialSpark platform) through drug acquisition (subsidiary factory) through AI development (Muse/OpenAI) through drug sales (Sanofi €545M) through regulatory environment (Kupor at OPM, Krishnan at White House, Friedberg at PCAST). Every stage is connected to the same network. No stage requires an entity outside the network to function.

The LabCorp / Covance Vertical

LabCorp provides infrastructure that touches multiple stages of the Formation Bio pipeline:

LABCORP CORPORATE UMBRELLA
    │
    ├── Covance (CRO — contract research organization)
    │   └── Ken Somberg: CMO of Covance → CMO of TrialSpark (Nov 2019)
    │   └── Jamil Hantash: Director at Covance → founded Covalence Pharma (SEO contamination)
    │   └── Covance provided the CRO services TrialSpark aimed to replace/internalize
    │
    ├── Invitae (acquired by LabCorp — now "Labcorp Genetics")
    │   └── Genetic testing panels (cancer, cardiac, rare disease)
    │   └── Same CLIA regulatory scope as Speedy Sticks (phlebotomy) and uBiome (microbiome)
    │   └── Shares regulatory classification with entities in the Formation Bio address chain
    │
    └── Clinical laboratory services (specimen processing, diagnostics)
        └── LabCorp processes specimens from clinical trials run on platforms like TrialSpark

The LabCorp vertical closes a loop: LabCorp/Covance provided the CRO services that TrialSpark aimed to replace. Somberg brought Covance operational knowledge to TrialSpark. LabCorp then acquired Invitae (genetic testing), expanding into the same genomic data space that 23andMe occupied when it partnered with TrialSpark. The company that TrialSpark was built to displace (Covance/LabCorp) also acquired the genetic testing company (Invitae) that operates in the same regulatory space as TrialSpark’s address-mates (Speedy Sticks).

[INTEREST NODE — LOGGED FOR FUTURE INVESTIGATION] The full LabCorp/Covance vertical and its intersection with the Formation Bio pipeline requires a dedicated investigation pass. The Somberg career path (Covance CMO → TrialSpark CMO) is the confirmed personnel bridge. The Invitae acquisition, the regulatory scope overlap, and the Hantash/Covalence Pharma connection are additional nodes that need mapping.

The Sanofi Circle

Sanofi’s relationship with Formation Bio represents a different type of vertical build — not acquisition-based but relationship-based vertical integration, where a single partner occupies multiple stages simultaneously:

SANOFI RELATIONSHIP STACK
    │
    ├── COMMERCIAL PARTNER (Oct 2022)
    │   └── 3-year contract for "tech-enabled drug development capabilities"
    │   └── Sanofi pays TrialSpark for platform services
    │
    ├── INVESTOR (Jun 2024)
    │   └── Formation Bio $372M Series D
    │   └── Sanofi has equity stake in the company it's paying for services
    │
    ├── AI COLLABORATOR (Nov 2024)
    │   └── Muse platform co-developed with Formation Bio + OpenAI
    │   └── Sanofi co-builds the AI tool used to develop the drugs it will buy
    │
    └── DRUG BUYER (Jun 2025)
        └── Licenses gusacitinib from Libertas Bio for up to €545M
        └── Sanofi buys a drug FROM the company it invested in, partnered with, and co-built AI tools with

Each relationship justifies the next. The commercial partnership leads to investment (we like what we see). The investment leads to AI collaboration (we’re aligned). The AI collaboration leads to drug purchase (the AI found something worth buying). Individually, each step is standard pharma business development. Together, they create a closed circle where the buyer, investor, partner, and collaborator are all the same entity — and the price of the drug ($€545M) is negotiated between parties with interlocking financial interests.

The Nonprofit-to-Commercial Vertical

This is the vertical that originates from charitable funding and terminates in commercial revenue:

NONPROFIT FUNDING
    │
    ├── Jack Dorsey / Start Small LLC → $15M → OpenResearch (Nov 2020)
    ├── OpenAI nonprofit → $10M → UBI Charitable (2020)
    ├── OpenResearch → $1M → TrialSpark for Project Covalence (FY2020)
    │
    └── Altman personal → $14M via credit line → OpenResearch
    
PLATFORM INFRASTRUCTURE (built with nonprofit money)
    │
    ├── Project Covalence — COVID research platform
    │   └── Trademarked by TrialSpark as proprietary IP (34 days after launch)
    │   └── Used to test RTB-101 (failed NIBR drug) on nursing home residents
    │
    └── TrialSpark clinical trial platform (enhanced by Covalence infrastructure)
    
CORPORATE TRANSFORMATION
    │
    ├── TrialSpark → Formation Bio rebrand (Dec 2023)
    ├── Libertas Bio subsidiary (incorporated Dec 2020 during Covalence)
    ├── Series C ($156M, Altman-led, Sep 2021)
    ├── Series D ($372M, a16z-led, Jun 2024)
    │
    └── Drug acquisition model activated using platform built with nonprofit money
    
COMMERCIAL REVENUE
    │
    └── Libertas Bio → Sanofi → up to €545M (Jun 2025)
        └── Revenue generated by company whose platform infrastructure
            was partially funded by nonprofit grants

The vertical converts charitable dollars into commercial revenue. $1M in nonprofit money helped build the platform. The platform was trademarked as proprietary IP. The IP was used to develop the company. The company acquired drugs. The drugs were licensed for €545M. The nonprofit money is long gone; the commercial value it helped create belongs entirely to the for-profit entity and its shareholders.

Why This Matters

Vertical integration is legal. It’s standard. It’s often efficient. But when the vertical is opaque — when entities at different stages are presented as independent, when nonprofit money enters at one end and commercial revenue exits at the other, when the regulatory environment is governed by people who recently sat on the board of the regulated company — the efficiency argument becomes a governance concern.

The question isn’t whether vertical integration is good or bad. The question is whether the people who benefit from the vertical are the same people who oversee it, fund it, regulate it, and report on it — and whether anyone outside the network has enough visibility to provide meaningful accountability.

In the Formation Bio vertical, the answer to that question is documented across the profiles in this investigation.

Nodes / Open Questions

Are there other verticals in the Altman network we haven’t mapped? The nuclear vertical (Oklo → Helion → OpenAI data centers → DOE/Wright) and the media vertical (a16z blog → Substack → SF Standard → All-In Podcast) are partially documented but haven’t been charted as verticals.
LabCorp deep dive: The Somberg-Covance-TrialSpark personnel bridge is confirmed. The Invitae acquisition, the regulatory scope overlap with Speedy Sticks, and the Hantash/Covalence Pharma connection need a dedicated pass.
The Speedy Sticks → One Care Health connection: BBB confirms they’re “related businesses.” One Care Health is addiction treatment in Staten Island, founded December 2020. What is the operational relationship? Shared ownership? Shared management? Does Speedy Sticks do blood draws for One Care Health’s patients?
How many other clinical trial platforms have this level of vertical integration? Is Formation Bio unique, or is this the industry standard? If it’s unique, the vertical is a competitive advantage. If it’s standard, the opacity is the only distinguishing feature.

The Personnel Pipeline Vertical

Vertical integration isn’t just about companies — it’s about PEOPLE. Where a company hires from and where its alumni go reveals the network connections that don’t appear on cap tables or press releases.

Data from a forum post (attributed to Isabella Holmes, propagated to business listing sites) documents TrialSpark’s hiring sources and alumni destinations:

Where TrialSpark Hires FROM

Source Company	Network Connection	What It Means
Oscar Health	Josh Kushner co-founded Oscar. Kareem Zaki (Thrive Capital) sits on BOTH Oscar’s board AND TrialSpark’s board.	Kushner’s health INSURANCE company is a hiring pool for Kushner’s PHARMA investment. Same investor controls both sides of the healthcare pipeline — the insurer that covers patients AND the company that develops drugs for them. Personnel flow between the two.
Palantir	Peter Thiel’s data analytics company. Thiel was YC visiting partner (2015-2017). Thiel co-founded OpenAI with Altman.	Thiel’s big-data analytics personnel → Altman’s drug development company. The data skills transfer from government/intelligence analytics to clinical trial analytics.
Flatiron Health	Oncology clinical data platform. Acquired by Roche for $1.9B (2018). Direct predecessor to TrialSpark’s business model.	TrialSpark hired from the company that PROVED a clinical-data-platform could exit for $1.9B. They didn’t just hire people — they hired the playbook. Flatiron showed the model works; TrialSpark hired the people who built it.
Google	Wesley Chan created Google Analytics at Google. Chan invested in TrialSpark (2018, 2021) and Formation Bio (2024) through Felicis and FPV.	Google personnel → TrialSpark. Chan’s investment follows the same path as the personnel. The data infrastructure expertise flows from web analytics to clinical analytics.
Microsoft	OpenAI’s largest investor (26.79% at $852B valuation).	Microsoft personnel → TrialSpark → Formation Bio partners with OpenAI → OpenAI’s largest investor is Microsoft. The personnel circle closes.
Columbia University Medical Center	Major NYC academic medical center	Clinical and research talent. Academic-to-industry pipeline.
Icahn School of Medicine at Mount Sinai	Major NYC medical school and hospital system	Clinical talent. Mount Sinai is also a potential clinical trial site network.
Zocdoc	Healthcare appointment/scheduling platform	Healthcare technology talent. Zocdoc’s patient-matching technology parallels TrialSpark’s trial-matching technology.

Where TrialSpark Alumni GO

Destination	Connection	What It Means
PPD	Major traditional CRO. Acquired by Thermo Fisher Scientific for $17.4B (2021).	TrialSpark alumni go to the traditional CRO industry that TrialSpark was built to disrupt. The people who learned the new model take their knowledge to the incumbents.
Trilogy Education	Ed-tech company. Acquired by 2U (2019).	Tech talent going to education technology.
Walt Disney Company	Entertainment/media	Marketing, content, or communications talent going to entertainment.
Aldo Sohm Wine Bar	Wine bar at Le Bernardin restaurant, NYC	Either a single person who left tech for hospitality, or a data entry artifact.

The Kushner Pipeline — Oscar Health ↔ TrialSpark

The Oscar Health → TrialSpark personnel flow deserves specific attention because it represents a captive labor market within a single investor’s portfolio:

Josh Kushner co-founded Oscar Health (health insurance, 2012)
Kareem Zaki (Thrive Capital, Kushner’s fund) sits on Oscar Health’s board
Kareem Zaki also sits on TrialSpark’s board (and later Formation Bio board observer)
Employees flow FROM Oscar TO TrialSpark — documented in hiring data

When the same investor’s representative governs both companies, and employees flow from one to the other, the “independent company” framing dissolves. Oscar Health (insurance) and TrialSpark/Formation Bio (pharma) are both governed by Kushner’s fund through the same partner (Zaki), with personnel flowing between them. The insurer that covers patients and the company that develops drugs for them share governance AND personnel.

This is the personnel dimension of the vertical integration documented in the Formation Bio vertical above. The companies are legally separate. The governance, investment, and personnel are integrated.

The Palantir → TrialSpark Data Skills Transfer

Palantir (Thiel) specializes in large-scale data analytics for government, intelligence, and healthcare. TrialSpark/Formation Bio specializes in clinical trial data analytics for pharmaceutical development. The skills are directly transferable: pattern recognition in large datasets, compliance with government data standards, infrastructure for sensitive data handling.

When Palantir-trained data analysts move to TrialSpark, they bring the analytical methodology developed for government surveillance and apply it to clinical trial patient data. The Thiel → Altman personnel pipeline runs through data science skills that work in both domains.

Benjamine Liu — Background Correction

Forbes (2022) confirms that Benjamine Liu immigrated to the United States from Taiwan as a child. He grew up in Westlake Village, California (suburban Los Angeles), attended Westlake High School, and is described as “a fiercely loyal Lakers fan.” His academic trajectory (Yale → Cambridge → Oxford) is entirely Western, but his origin is Taiwanese.

This contextualizes the Cherubic Ventures investment: Matt Cheng (Taiwanese-American, Taiwan’s former top junior tennis player) invested in a company founded by a fellow Taiwanese immigrant. The Taiwanese diaspora network is a documented channel for cross-border venture capital — Cheng’s entire thesis at Cherubic is US-Asia cross-border investing, and Liu represents the founder archetype Cheng specifically invests in.

It also contextualizes the geopolitical positioning: Formation Bio sources drugs from BOTH Taiwanese-connected investors (Cherubic) AND mainland Chinese biotech companies (Lynk Pharmaceuticals for Bleecker Bio’s TYK2 inhibitor). Liu operates across the Taiwan-China divide commercially, regardless of personal origin. Whether this represents pragmatic business development or strategic positioning in the US-China biotech competition is an open question.

Sources

[Archive] Prior investigation sessions — Formation Bio vertical mapped across multiple sessions: 23andMe partnership (Sep 2019), Speedy Sticks at 16 E 34th, Somberg Covance → TrialSpark, subsidiary factory (Libertas/Riverview/High Line/Bleecker), Muse platform (Nov 2024), Sanofi €545M (Jun 2025), Kupor Formation Bio board → OPM. All confirmed.
[Archive] BBB — One Care Health, LLC profile: “Related Businesses: Speedy Sticks, LLC.” 97 Port Richmond Ave, Staten Island. Founded Dec 2, 2020. CEO Dr. Carlos M. Barrera: https://www.bbb.org/us/ny/staten-island/profile/urgent-care-clinic/one-care-health-llc-0121-87147158
[Archive] NIH GTR — “Labcorp Genetics (formerly Invitae)” — LabCorp acquired Invitae: https://www.ncbi.nlm.nih.gov/gtr/labs/500031/
[Archive] OpenGovUS — Open Research Lab, Inc. SAM registration: 469 9th St, Fl 2, Oakland. UEI KQZAZ55N2EE1. Officer: Chris Clark. Activated Dec 5, 2022. Expired Dec 1, 2023: https://opengovus.com/sam-entity/KQZAZ55N2EE1

This analysis does not constitute evidence of illegal action. The opinions expressed here are the professional opinions and analytical conclusions of the author, a published corporate ethics researcher and analyst specializing in business leadership ethics, governance structures, and nonprofit compliance. Readers are encouraged to examine the primary sources cited above and draw their own conclusions.

A conflict does not become less important because it was routed through a quieter entity. It becomes more important to map.

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