0000899243-23-004990.txt : 20230214 0000899243-23-004990.hdr.sgml : 20230214 20230214163532 ACCESSION NUMBER: 0000899243-23-004990 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221231 FILED AS OF DATE: 20230214 DATE AS OF CHANGE: 20230214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILNE GEORGE M JR CENTRAL INDEX KEY: 0001179552 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41199 FILM NUMBER: 23630403 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Amylyx Pharmaceuticals, Inc. CENTRAL INDEX KEY: 0001658551 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 464600503 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 43 THORNDIKE STREET CITY: CAMBRIDGE STATE: MA ZIP: 02141 BUSINESS PHONE: 617-683-0917 MAIL ADDRESS: STREET 1: 43 THORNDIKE STREET CITY: CAMBRIDGE STATE: MA ZIP: 02141 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2022-12-31 0 0 1 0001658551 Amylyx Pharmaceuticals, Inc. AMLX 0001179552 MILNE GEORGE M JR C/O AMYLYX PHARMACEUTICALS, INC. 43 THORNDIKE STREET CAMBRIDGE MA 02141 1 0 0 0 Common Stock 2022-01-06 4 C 0 689425 A 910821 D Common Stock 2022-12-29 5 G 0 13800 0.00 D 897021 D Series A Preferred Stock 2022-01-06 4 C 0 262282 0.00 D Common Stock 262282 0 D Series B Preferred Stock 2022-01-06 4 C 0 384449 0.00 D Common Stock 384449 0 D Series C-1 Preferred Stock 2022-01-06 4 C 0 19482 0.00 D Common Stock 19482 0 D Series C-2 Preferred Stock 2022-01-06 4 C 0 23212 0.00 D Common Stock 23212 0 D Upon the closing of the Issuer's initial public offering, all shares of Series A, Series B, Series C-1 and Series C-2 Preferred Stock (the "Preferred Stock") automatically converted into the number of shares of the Issuer's Common Stock shown in column 4 of Table I without payment or further consideration. The Preferred Stock had no expiration date. /s/ Joshua B. Cohen, as Attorney-in-Fact 2023-02-14