# EDGAR Filing Document

**Accession Number:** 0001253170
**File Stem:** 0001628280-23-003923
**Filing Date:** 2023-2
**Character Count:** 8329
**Document Hash:** cd9f4551cd3fc8bc088fd37a4fe106ad
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001628280-23-003923.hdr.sgml**: 20230216

**ACCESSION NUMBER**: 0001628280-23-003923

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230214

**FILED AS OF DATE**: 20230216

**DATE AS OF CHANGE**: 20230216

**REPORTING-OWNER**: 

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

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-41614
- **FILM NUMBER:** 23639184

**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:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-41614
- **FILM NUMBER:** 23639183

**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

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

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **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. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-14 | **5. 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>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Mineralys Therapeutics, Inc. [ MLYS ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<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. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-14 | **5. 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>_ _ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Mineralys Therapeutics, Inc. [ MLYS ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<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

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2023-02-14 |  | C |  | 3581861 | A | <sup>(1)</sup> | 3581861 | I | See footnote<sup>(2)</sup> |
| Common Stock | 2023-02-14 |  | P |  | 937500 | A | $16 | 4519361 | I | See footnote<sup>(2)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Series A Preferred Stock | <sup>(1)</sup> | 2023-02-14 |  | C |  |  | 2135504 | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 2135504.0 | $0 | 0 | I | See footnote<sup>(2)</sup> |
| Series B Preferred Stock | <sup>(1)</sup> | 2023-02-14 |  | C |  |  | 1446357 | <sup>(1)</sup> | <sup>(1)</sup> | Common Stock | 1446357.0 | $0 | 0 | I | See footnote<sup>(2)</sup> |

---

### Footnotes:

(1) Each share of preferred stock of the Issuer automatically converted 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) upon closing of the Issuer's initial 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.

**Signature:** /s/ Srinivas Akkaraju  
**Date:** 2023-02-16

**Signature:** Samsara BioCapital, L.P. By: Samsara BioCapital GP, LLC, its General Partner, By /s/ Srinivas Akkaraju, Managing Member  
**Date:** 2023-02-16

### 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.**