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