SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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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*
Witney Frank

(Last) (First) (Middle)
C/O TELESIS BIO INC.
10431 WATERIDGE CIRCLE, SUITE 150

(Street)
SAN DIEGO CA 92121

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Telesis Bio Inc. [ TBIO ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
07/06/2023
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 07/06/2023 A 46,752(1) A $0 67,382 D
Common Stock 05/01/2024 A 48,354(2) A $0 115,736 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (right to buy) $1.54 07/06/2023 A 70,129 (3) 07/06/2033 Common Stock 70,129 $0 70,129 D
Stock Option (right to buy) $0.3557 05/01/2024 A 30,362 (3) 05/01/2034 Common Stock 30,362 $0 30,362 D
Explanation of Responses:
1. The Reporting Person was granted restricted stock units ("RSUs"), which represent a contingent right to receive one share of Issuer's Common Stock for each RSU. Subject to the Reporting Person continuing as a Service Provider (as defined in the Issuer's 2021 Stock Incentive Plan (the "Plan")) through such date, 100% of the RSUs shall vest on the earlier of the one-year anniversary of the date of grant or on the date of the annual meeting of the Issuer's stockholders following the date of grant.
2. The Reporting Person was granted RSUs, which represent a contingent right to receive one share of Issuer's Common Stock for each RSU. Subject to the Reporting Person continuing as a Service Provider (as defined in the Plan) through each applicable date, 28,113 of the RSUs shall vest on January 1, 2025, and 20,241 of the RSUs shall vest on the earlier of the one-year anniversary of the date of grant or on the date of the annual meeting of the Issuer's stockholders following the date of grant.
3. Subject to the Reporting Person continuing as a Service Provider (as defined in the Plan) through such date, 100% of the shares subject to the option shall vest on the earlier of the one-year anniversary of the date of grant or on the date of the annual meeting of the Issuer's stockholders following the date of grant.
/s/ Frank Witney 05/03/2024
** 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 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.
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