0001209191-19-038135.txt : 20190619 0001209191-19-038135.hdr.sgml : 20190619 20190619185052 ACCESSION NUMBER: 0001209191-19-038135 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190619 FILED AS OF DATE: 20190619 DATE AS OF CHANGE: 20190619 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ninth MDV Partners, L.L.C. CENTRAL INDEX KEY: 0001573991 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 19907159 BUSINESS ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 BUSINESS PHONE: 650-234-4840 MAIL ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MDV IX LP CENTRAL INDEX KEY: 0001410787 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 19907160 BUSINESS ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 BUSINESS PHONE: 650-234-4840 MAIL ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MDV ENF IX LP CENTRAL INDEX KEY: 0001435083 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 19907161 BUSINESS ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 BUSINESS PHONE: 6502344840 MAIL ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FEIBER JONATHAN D CENTRAL INDEX KEY: 0001027621 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 19907162 MAIL ADDRESS: STREET 1: 3000 SAND HILL ROAD BLDG 1 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ericson William W. CENTRAL INDEX KEY: 0001503381 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 19907163 MAIL ADDRESS: STREET 1: 777 MARINERS ISLAND BOULEVARD STREET 2: SUITE 550 CITY: SAN MATEO STATE: CA ZIP: 94404 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Personalis, Inc. CENTRAL INDEX KEY: 0001527753 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 275411038 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1330 O'BRIEN DRIVE CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-752-1300 MAIL ADDRESS: STREET 1: 1330 O'BRIEN DRIVE CITY: MENLO PARK STATE: CA ZIP: 94025 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2019-06-19 0 0001527753 Personalis, Inc. PSNL 0001573991 Ninth MDV Partners, L.L.C. 777 MARINERS ISLAND BOULEVARD SUITE 550 SAN MATEO CA 94404 0 0 1 0 0001410787 MDV IX LP 777 MARINERS ISLAND BOULEVARD SUITE 550 SAN MATEO CA 0 0 1 0 0001435083 MDV ENF IX LP 777 MARINERS ISLAND BOULEVARD SUITE 550 SAN MATEO CA 94404 0 0 1 0 0001027621 FEIBER JONATHAN D 777 MARINERS ISLAND BOULEVARD SUITE 550 SAN MATEO CA 94404 0 0 1 0 0001503381 Ericson William W. 777 MARINERS ISLAND BOULEVARD SUITE 550 SAN MATEO CA 94404 0 0 1 0 Series A Convertible Preferred Stock Common Stock 2288805 I See Footnote Series A Convertible Preferred Stock Common Stock 18739 I See Footnote Series B Convertible Preferred Stock Common Stock 107812 I See Footnote Series B Convertible Preferred Stock Common Stock 882 I See Footnote Series C Convertible Preferred Stock Common Stock 61592 I See Footnote Series C Convertible Preferred Stock Common Stock 504 I See Footnote Series C Convertible Preferred Stock Common Stock 127504 I See Footnote The Series A Convertible Preferred Stock, Series B Convertible Preferred Stock and Series C Convertible Preferred Stock shall automatically convert into Common Stock on a 1-for-1 basis immediately prior to the completion of the Issuer's initial public offering and has no expiration date. These shares are held directly by MDV IX, L.P. ("MDV IX"). Ninth MDV Partners, L.L.C. ("Ninth MDV") is the general partner of MDV IX. Jonathan Feiber and William Ericson are the managing members of Ninth MDV and either are deemed to have sole voting and dispositive power with respect to the shares held by MDV IX. Each disclaims beneficial ownership of these securities except to the extent of his or its respective pecuniary interest therein. These shares are held directly by MDV ENF IX, L.P. ("ENF IX"). Ninth MDV is the general partner of ENF IX. Jonathan Feiber and William Ericson are the managing members of Ninth MDV and either are deemed to have sole voting and dispositive power with respect to the shares held by ENF IX. Each disclaims beneficial ownership of these securities except to the extent of his or its respective pecuniary interest therein. These shares are held directly by MDV IX, L.P., as nominee for MDV IX, L.P. and MDV ENF IX, L.P. ("IX Funds"). Ninth MDV is the general partner of IX Funds. Jonathan Feiber and William Ericson are the managing members of Ninth MDV and either are deemed to have sole voting and dispositive power with respect to the shares held by IX Funds. Each disclaims beneficial ownership of these securities except to the extent of his or its respective pecuniary interest therein. /s/ Ninth MDV Partners, L.L.C., By: Brett Teele, Authorized Signatory 2019-06-19 /s/ MDV IX, L.P., By: Ninth MDV Partners, L.L.C., its General Partner, By: Brett Teele, Authorized Signatory 2019-06-19 /s/ MDV ENF IX, L.P., By: Ninth MDV Partners, L.L.C., its General Partner, By: Brett Teele, Authorized Signatory 2019-06-19 /s/ Jonathan Feiber 2019-06-19 /s/ William Ericson 2019-06-19