0001104659-24-012328.txt : 20240208 0001104659-24-012328.hdr.sgml : 20240208 20240208164933 ACCESSION NUMBER: 0001104659-24-012328 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: AMERICAN HOME ASSURANCE CO CENTRAL INDEX KEY: 0000005181 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41942 FILM NUMBER: 24609838 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 tm245543-1_4seq1.xml OWNERSHIP DOCUMENT X0508 4 2024-02-06 1 0001572616 Fractyl Health, Inc. GUTS 0000005181 AMERICAN HOME ASSURANCE CO 1271 AVENUE OF THE AMERICAS NEW YORK NY 10020-1304 0 0 1 0 0 Common Stock 2024-02-06 4 C 0 283878 A 283878 D Series E Preferred Shares 2024-02-06 4 C 0 494173 0 D Common Stock 230276 0 D Series F Preferred Shares 2024-02-06 4 C 0 115030 0 D Common Stock 53602 0 D The Series E Convertible Preferred Stock and Series F Convertible Preferred Stock (together, the "Preferred Shares") automatically converted into shares of the Issuer's common stock, for no additional consideration, immediately prior to the closing of the Issuer's initial public offering of common stock, at a conversion ratio of 1 share of Common Stock for 2.146 Preferred Shares. The Preferred Shares had no expiration date. American Home Assurance Company is a wholly owned, indirect subsidiary of American International Group, Inc. /s/ Tanya Kent, Secretary 2024-02-08