0000950170-24-012836.txt : 20240208 0000950170-24-012836.hdr.sgml : 20240208 20240208163724 ACCESSION NUMBER: 0000950170-24-012836 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240206 FILED AS OF DATE: 20240208 DATE AS OF CHANGE: 20240208 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Caplan Jay David CENTRAL INDEX KEY: 0001419217 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41942 FILM NUMBER: 24609689 MAIL ADDRESS: STREET 1: 34 CLARK STREET CITY: BELMONT STATE: MA ZIP: 02478 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Fractyl Health, Inc. CENTRAL INDEX KEY: 0001572616 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] ORGANIZATION NAME: 08 Industrial Applications and Services IRS NUMBER: 273553477 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 17 HARTWELL AVENUE CITY: LEXINGTON STATE: MA ZIP: 02421 BUSINESS PHONE: 781-902-8800 MAIL ADDRESS: STREET 1: 17 HARTWELL AVENUE CITY: LEXINGTON STATE: MA ZIP: 02421 FORMER COMPANY: FORMER CONFORMED NAME: Fractyl Laboratories Inc. DATE OF NAME CHANGE: 20130320 4 1 ownership.xml 4 X0508 4 2024-02-06 0001572616 Fractyl Health, Inc. GUTS 0001419217 Caplan Jay David 17 HARTWELL AVENUE LEXINGTON MA 02421 false true false false President, Chief Product Off. false Common Stock 2024-02-06 4 C false 23299 A 358806 I By Trust Common Stock 2024-02-06 4 C false 118810 A 118810 I By Family Trust Series A Preferred Stock 2024-02-06 4 C false 50000 D Common Stock 23299 0 I By Trust Series B Preferred Stock 2024-02-06 4 C false 177726 D Common Stock 82817 0 I By Family Trust Series C-1 Preferred Stock 2024-02-06 4 C false 44730 D Common Stock 20843 0 I By Family Trust Series C-2 Preferred Stock 2024-02-06 4 C false 32514 D Common Stock 15150 0 I By Family Trust In connection with the closing of the Issuer's initial public offering, each share of preferred stock automatically converted into common stock in accordance with the terms of such preferred stock. The Reporting Person's Form 3 filed on February 1, 2024 inadvertently omitted the securities held by the Jay D. Caplan 2021 Irrevocable Trust. /s/ Lisa A. Davidson, Attorney-in-fact 2024-02-08