0000950170-24-107527.txt : 20240917
0000950170-24-107527.hdr.sgml : 20240917
20240917200734
ACCESSION NUMBER: 0000950170-24-107527
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240916
FILED AS OF DATE: 20240917
DATE AS OF CHANGE: 20240917
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Hawryluk P. Kent
CENTRAL INDEX KEY: 0001673991
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-42272
FILM NUMBER: 241305893
MAIL ADDRESS:
STREET 1: 17199 N. LAUREL PARK DRIVE
STREET 2: SUITE 401
CITY: LIVONIA
STATE: MI
ZIP: 48152
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: MBX Biosciences, Inc.
CENTRAL INDEX KEY: 0001776111
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
ORGANIZATION NAME: 03 Life Sciences
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 12406 HORESHAM STREET
CITY: CARMEL
STATE: IN
ZIP: 46032
BUSINESS PHONE: 3179893100
MAIL ADDRESS:
STREET 1: 12406 HORESHAM STREET
CITY: CARMEL
STATE: IN
ZIP: 46032
4
1
ownership.xml
4
X0508
4
2024-09-16
0001776111
MBX Biosciences, Inc.
MBX
0001673991
Hawryluk P. Kent
C/O MBX BIOSCIENCES, INC.
11711 N. MERIDIAN STREET, SUITE 300
CARMEL
IN
46032
true
true
false
false
President & CEO
false
Common Stock
2024-09-16
4
C
false
283846
A
481397
D
Common Stock
2024-09-16
4
C
false
115914
A
398277
I
By Trust
Series A Convertible Preferred Stock
2024-09-16
4
C
false
2015681
D
Common Stock
167664
0
D
Series A Convertible Preferred Stock
2024-09-16
4
C
false
345705
D
Common Stock
28755
0
I
By Trust
Series B Convertible Preferred Stock
2024-09-16
4
C
false
1396762
D
Common Stock
116182
0
D
Series B Convertible Preferred Stock
2024-09-16
4
C
false
76969
D
Common Stock
6402
0
I
By Trust
Series C Convertible Preferred Stock
2024-09-16
4
C
false
970873
D
Common Stock
80757
0
I
By Trust
Each share of Series A Convertible Preferred Stock, Series B Convertible Preferred Stock and Series C Convertible Preferred Stock (collectively, the "Preferred Stock") was convertible into Common Stock on a one-for-12.0221 basis at any time at the option of the holder, and automatically converted into the number of shares shown in Column 7 immediately prior to the closing of the Issuer's initial public offering on September 16, 2024. The Preferred Stock had no expiration date.
Shares held by the P. Kent Hawryluk Revocable Trust dated January 25, 2011, of which the Reporting Person serves as trustee. The Reporting Person disclaims beneficial ownership except to the extent of any pecuniary interest therein, and this report shall not be deemed an admission that such shares are beneficially owned by him for Section 16 or any other purpose.
/s/ Richard Bartram, attorney-in-fact
2024-09-17