0001225208-24-001417.txt : 20240201 0001225208-24-001417.hdr.sgml : 20240201 20240201191652 ACCESSION NUMBER: 0001225208-24-001417 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240201 FILED AS OF DATE: 20240201 DATE AS OF CHANGE: 20240201 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: AMERICAN HOME ASSURANCE CO CENTRAL INDEX KEY: 0000005181 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41942 FILM NUMBER: 24588398 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 3 1 doc3.xml X0206 3 2024-02-01 0 0001572616 Fractyl Health, Inc. GUTS 0000005181 AMERICAN HOME ASSURANCE CO 1271 AVE OF THE AMERICAS NEW YORK NY 10020-1304 1 Series E Preferred Shares Common Stock 230276.0000 D Series F Preferred Shares Common Stock 53602.0000 D The Series E Convertible Preferred Stock and Series F Convertible Preferred Stock (together, the "Preferred Shares") are convertible into shares of the Issuer's common stock, at the option of the stockholder, at any time, and for no additional consideration, at an initial conversion ratio of 1-for-1, as adjusted for the Reverse Stock Split (defined in footnote 2). The Preferred Shares have no expiration date. The Preferred Shares will automatically convert into shares of the Issuer's common stock immediately prior to the closing of the Issuer's initial public offering of common stock. Reflects a 1-for-2.146 reverse stock split of the Issuer's common stock effected on January 26, 2024 (the "Reverse Stock Split"). American Home Assurance Company is a wholly owned, indirect subsidiary of American International Group, Inc. /s/ Tanya Kent, Secretary 2024-02-01