0000950170-24-012838.txt : 20240208 0000950170-24-012838.hdr.sgml : 20240208 20240208163735 ACCESSION NUMBER: 0000950170-24-012838 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: Royan Ajay CENTRAL INDEX KEY: 0001875614 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41942 FILM NUMBER: 24609693 MAIL ADDRESS: STREET 1: 303 WYMAN STREET STREET 2: SUITE 300 CITY: WALTHAM STATE: MA ZIP: 02451 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 0001875614 Royan Ajay C/O FRACTYL HEALTH, INC. 17 HARTWELL AVENUE LEXINGTON MA 02421 true false true false false Common Stock 2024-02-06 4 C false 5160301 A 5160301 I See footnote Common Stock 2024-02-06 4 C false 918567 A 918567 I See footnote Common Stock 2024-02-06 4 P false 333333 15.00 A 1251900 I See footnote Series C-1 Preferred Stock 2024-02-06 4 C false 4025764 D Common Stock 1875938 0 I See footnote Series C-2 Preferred Stock 2024-02-06 4 C false 6502796 D Common Stock 3030193 0 I See footnote Series D Preferred Stock 2024-02-06 4 C false 545450 D Common Stock 254170 0 I See footnote Series E Preferred Stock 2024-02-06 4 C false 373021 D Common Stock 173821 0 I See footnote Series F Preferred Stock 2024-02-06 4 C false 1598225 D Common Stock 744746 0 I See footnote In connection with the closing of the Issuer's initial public offering, each share of preferred stock automatically converted into 0.466 shares of the Issuer's common stock in accordance with the terms of such preferred stock. Represents securities held by Mithril LP ("LP"). Mithril GP LP ("GP LP") is the general partner of LP and may be deemed to have shared voting and dispositive power with respect to the securities held by LP. The Reporting Person is the authorized person of GP LP and a member of the investment committee of GP LP, and in such capacity may be deemed to have beneficial ownership of the securities held by LP. The Reporting Person disclaims such beneficial ownership except to the extent of his pecuniary interest therein, if any. Represents securities held by Mithril II LP ("II LP"). Mithril II UGP LLC ("UGP II") is the general partner of Mithril II GP LP ("GP II"), which is the general partner of II LP, and each of UGP II and GP II may be deemed to have shared voting and dispositive power with respect to the securities held by II LP. The Reporting Person is the sole managing member of UGP II and a member of the investment committee of GP II, and in such capacity may be deemed to have beneficial ownership of the securities held by II LP. The Reporting Person disclaim such beneficial ownership except to the extent of his pecuniary interest therein, if any. /s/ Lisa A. Davidson as Attorney-in-Fact for Ajay Royan 2024-02-08