# EDGAR Filing Document

**Accession Number:** 0001699737
**File Stem:** 0001628280-23-003037
**Filing Date:** 2023-2
**Character Count:** 11550
**Document Hash:** d20d1756eec4f8fd2b5d737c3b26b7ca
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001628280-23-003037.hdr.sgml**: 20230209

**ACCESSION NUMBER**: 0001628280-23-003037

**CONFORMED SUBMISSION TYPE**: 3

**PUBLIC DOCUMENT COUNT**: 2

**CONFORMED PERIOD OF REPORT**: 20230209

**FILED AS OF DATE**: 20230209

**DATE AS OF CHANGE**: 20230209

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** AKKARAJU SRINIVAS
- **CENTRAL INDEX KEY:** 0001253170

**FILING VALUES:**
- **FORM TYPE:** 3
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-41614
- **FILM NUMBER:** 23608031

**MAIL ADDRESS:**
- **STREET 1:** 565 EVERETT AVENUE
- **CITY:** PALO ALTO
- **STATE:** CA
- **ZIP:** 94301
**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Samsara BioCapital, L.P.
- **CENTRAL INDEX KEY:** 0001699737
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 3
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-41614
- **FILM NUMBER:** 23608032

**BUSINESS ADDRESS:**
- **STREET 1:** 628 MIDDLEFIELD ROAD
- **CITY:** PALO ALTO
- **STATE:** CA
- **ZIP:** 94301
- **BUSINESS PHONE:** (650) 285-4270

**MAIL ADDRESS:**
- **STREET 1:** 628 MIDDLEFIELD ROAD
- **CITY:** PALO ALTO
- **STATE:** CA
- **ZIP:** 94301
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Mineralys Therapeutics, Inc.
- **CENTRAL INDEX KEY:** 0001933414
- **STANDARD INDUSTRIAL CLASSIFICATION:** PHARMACEUTICAL PREPARATIONS [2834]
- **IRS NUMBER:** 000000000
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 150 N. RADNOR CHESTER ROAD
- **STREET 2:** SUITE F200
- **CITY:** RADNOR
- **STATE:** PA
- **ZIP:** 19087
- **BUSINESS PHONE:** (888) 378-6240

**MAIL ADDRESS:**
- **STREET 1:** 150 N. RADNOR CHESTER ROAD
- **STREET 2:** SUITE F200
- **CITY:** RADNOR
- **STATE:** PA
- **ZIP:** 19087

## Ex-24

```
<pre>
POWER OF ATTORNEY

    Know all by these presents, that the undersigned hereby constitutes and appoints each of the Chief Executive Officer, who is currently Jon Congleton, and the Chief Financial Officer, who is currently Adam Levy, and their respective successors, signing singly, the undersigned's true and lawful attorney-in-fact to:

    (1)       prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the U.S. Securities and Exchange Commission (the "SEC") a Form ID, including amendments thereto, and any other documents necessary or appropriate to obtain codes and passwords enabling the undersigned to make electronic filings with the SEC of reports required by Section
16(a) of the Securities Exchange Act of 1934 or any rule or regulation of the SEC;

    (2)       execute for and on behalf of the undersigned, in the undersigned's capacity as an officer and/or director of Mineralys Therapeutics, Inc., a Delaware corporation (the "Company") and/or beneficial owner of more than 10% of the Company's capital stock, Forms 3, 4, and 5 and any amendments thereto in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder;

    (3)       do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4, or 5, complete and execute any amendment or amendments thereto, and timely file such form with the SEC and any stock exchange or similar authority; and

    (4)       take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney- in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in- fact's discretion.

    The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934.

    The undersigned agrees that each such attorney-in-fact herein may rely entirely on information furnished orally or in writing by the undersigned to such attorney-in-fact.  The undersigned also agrees to indemnify and hold harmless the Company and each such attorney-in-fact against an losses, claims, damages or liabilities (or actions in these reports) that arise out of or are based upon any untrue statements or omission of necessary facts in the information provided by the undersigned to such attorney-in-fact for purposes of executing, acknowledging, delivering or filing Forms 3, 4 or 5 (including amendments
thereto) or Form ID and agrees to reimburse the Company and such attorney-in-fact for any legal or other expenses reasonably incurred in connection with investigating or defending against any such loss, claim, damage, liability or action.
This Power of Attorney supersedes any power of attorney previously executed by the undersigned regarding the purposes outlined in the first paragraph hereof ("Prior Powers of Attorney"), and the authority of the attorney-in-fact named in any Prior Powers of Attorney is hereby revoked.

    This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact.

[Signature Page to Follow]

    IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as
of this  6th

day of February, 2023.

/s/Srinivas Akkaraju
Name:  Srinivas Akkaraju
</pre>
```

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 3

### INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>AKKARAJU SRINIVAS<br><sub>(Last) (First) (Middle)</sub><br>628 MIDDLEFIELD ROAD<br><sub>(Street)</sub><br>PALO ALTO, CA 94301<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>Mineralys Therapeutics, Inc. [ MLYS ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2023-02-09 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director   [X] 10% Owner<br>[ ] Officer (give title below)   [ ] Other (specify below)<br>_ _ | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Samsara BioCapital, L.P.<br><sub>(Last) (First) (Middle)</sub><br>628 MIDDLEFIELD ROAD<br><sub>(Street)</sub><br>PALO ALTO, CA 94301<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>Mineralys Therapeutics, Inc. [ MLYS ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2023-02-09 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director   [X] 10% Owner<br>[ ] Officer (give title below)   [ ] Other (specify below)<br>_ _ | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[ ] Form filed by One Reporting Person<br>[X] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities Beneficially Owned

---

|  |  |  |  |
| --- | --- | --- | --- |
| 1. Title of Security | 2. Amount of Securities Beneficially Owned | 3. Ownership Form | 4. Nature of Indirect Beneficial Ownership |

---

## Table II - Derivative Securities Beneficially Owned

---

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Underlying Securities | 3. Title and Amount of Underlying Securities | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| Series A Preferred Stock | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 2135504.0 | <sup>(1)</sup> | I | See footnote<sup>(2)</sup> |
| Series B Preferred Stock | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 1446357.0 | <sup>(1)</sup> | I | See footnote<sup>(2)</sup> |

---

### Footnotes:

(1) Each share of preferred stock of the Issuer is convertible into shares of common stock on a 10.798-for-one basis (which reflects the reverse stock split effected by the Issuer on February 1, 2023) at any time. The preferred stock will automatically convert into common stock upon closing of the Issuer's public offering.

(2) Represents securities held directly by Samsara BioCapital, L.P. Samsara BioCapital GP, LLC (Samsara LLC) is the general partner of Samsara BioCapital, L.P. (Samsara LP) and may be deemed to beneficially own the shares held by Samsara LP. Dr. Akkaraju has voting and investment power over the shares held by Samsara LP and, accordingly, may be deemed to beneficially own the shares held by Samsara LP. Each of Samsara LLC and Dr. Akkaraju disclaims beneficial ownership in these shares except to the extent of his or its respective pecuniary interest therein.

**Remarks:**
EXHIBIT LIST: EX-24 Srinivas Akkaraju POA

**Signature:** /s/ Srinivas Akkaraju  
**Date:** 2023-02-09

**Signature:** Samsara BioCapital, L.P. By: Samsara BioCapital GP, LLC, its General Partner, By /s/ Srinivas Akkaraju, Managing Member  
**Date:** 2023-02-09

### Remarks:

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 4 (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).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**