SCHEDULE 13G/A 0001172661-24-001211 0001595725 XXXXXXXX LIVE 5 Common Stock, par value $0.0001 per share 07/03/2025 0001683553 Spruce Biosciences, Inc. 85209E109 611 Gateway Boulevard Suite 740 South San Francisco CA 94080 Rule 13d-1(c) Rock Springs Capital Management LP DE 0.00 0.00 0.00 0.00 0.00 N 0 IA Rock Springs Capital LLC E9 0.00 0.00 0.00 0.00 0.00 N 0 HC OO Rock Springs Capital Master Fund LP E9 0.00 0.00 0.00 0.00 0.00 N 0 IA Mark Bussard X1 0.00 0.00 0.00 0.00 0.00 N 0 HC IN Kris Jenner X1 0.00 0.00 0.00 0.00 0.00 N 0 HC IN Spruce Biosciences, Inc. 611 Gateway Boulevard, Suite 740, South San Francisco, California 94080 This Statement is filed on behalf of each of the following persons (collectively, the "Reporting Persons"): i. Rock Springs Capital Management LP ("RSCM"); ii. Rock Springs Capital Master Fund LP ("Master Fund"); and iii. Rock Springs Capital LLC ("RSC"); iv. Mark Bussard v. Kris Jenner This Statement relates to shares (as defined herein) held directly by the Master Fund, which is a Cayman Island exempted limited partnership, and Four Pines Master Fund LP ("Four Pines"), which is a Cayman Islands exempted limited partnership, and indirectly held by RSCM, a Delaware limited partnership, and RSC, a Delaware limited liability company. RSCM serves as the investment manager to each of the Master Fund and Four Pines. RSC is the general partner of RSCM. Mark Bussard and Kris Jenner each own 50% of the management company. Rock Springs Capital Management LP, Rock Springs Capital LLC, Rock Springs Capital Master Fund LP, Mark Bussard, and Kris Jenner: 650 South Exeter, Suite 1070 Baltimore, MD 21202 Rock Springs Capital Management LP - Delaware Rock Springs Capital Master Fund LP - Cayman Islands Rock Springs Capital LLC - Delaware Mark Bussard - United States Kris Jenner - United States Y 0 0% 0 0 0 0 N Y N See disclosure in Items 2 and 4 hereof. Certain funds listed in Item 2(a) are known to have the right to receive or the power to direct the receipt of dividends from, or the proceeds from the sale of, the shares covered by this Statement that may be deemed to be beneficially owned by the Reporting Persons. N Please see response to Item 2. Y Y N By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect, other than activities solely in connection with a nomination under ?? 240.14a-11. JOINT FILING STATEMENT PURSUANT TO RULE 13d-1(k) The undersigned acknowledge and agree that the foregoing statement on SCHEDULE 13G/A, is filed on behalf of each of the undersigned and that all subsequent amendments to this statement on SCHEDULE 13G/A, shall be filed on behalf of each of the undersigned without the necessity of filing additional joint acquisition statements. The undersigned acknowledge that each shall be responsible for the timely filing of such amendments, and for the completeness and accuracy of the information concerning him or it contained therein, but shall not be responsible for the completeness and accuracy of the information concerning the others, except to the extent that he or it knows or has reason to believe that such information is inaccurate. Dated: August 13, 2025 Rock Springs Capital Management LP By: Rock Springs Capital LLC, General Partner By: Mark Bussard Name: Mark Bussard Title: Member Rock Springs Capital LLC By: Mark Bussard Name: Mark Bussard Title: Member Rock Springs Capital Master Fund LP By: Rock Springs Capital Management LP, Investment Manager By: Rock Springs Capital LLC, General Partner By: Mark Bussard Name: Mark Bussard Title: Member Mark Bussard By: Mark Bussard Name: Mark Bussard Kris Jenner By: Kris Jenner Name: Kris Jenne Rock Springs Capital Management LP Mark Bussard 08/13/2025 Rock Springs Capital LLC Mark Bussard 08/13/2025 Rock Springs Capital Master Fund LP Mark Bussard 08/13/2025 Mark Bussard Mark Bussard 08/13/2025 Kris Jenner Kris Jenner 08/13/2025