SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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1. Name and Address of Reporting Person*
Klee Justin B.

(Last) (First) (Middle)
C/O AMYLYX PHARMACEUTICALS, INC.
43 THORNDIKE STREET

(Street)
CAMBRIDGE MA 02142

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/06/2022
3. Issuer Name and Ticker or Trading Symbol
Amylyx Pharmaceuticals, Inc. [ AMLX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Co-Chief Executive Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 2,484,195 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) (1) 02/16/2023 Common Stock 334,520 0.37 D
Stock Option (Right to Buy) (2) 02/26/2025 Common Stock 100,000 1.57 D
Stock Option (Right to Buy) (3) 02/19/2026 Common Stock 200,000 7.57 D
Series C-1 Preferred Stock (4) (4) Common Stock 4,870 (4) D
Explanation of Responses:
1. 6,977 shares subject to such stock option vested and became exercisable on March 16, 2018 and the remainder of the shares vest in monthly installments of 6,969 shares for a period of 47 months after the vesting commencement date.
2. 25,012 shares subject to such option vested and became exercisable on February 26, 2021 and the remainder of the shares vest in monthly installments of 2,083 shares thereafter.
3. 50,024 shares subject to such option shall vest and become exercisable on February 19, 2022 and the remainder of the shares vest in monthly installments of 4,166 shares thereafter.
4. Each share of Series C-1 preferred stock is convertible on a one-for-one basis into Common Stock at any time at the election of the Reporting Person and will automatically convert upon the closing of the Issuer's initial public offering into the number of shares of the Issuer's Common Stock shown in column 3 without payment or further consideration. The Series C-1 Preferred stock has no expiration date.
Remarks:
/s/ Justin Klee 01/06/2022
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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