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*
BALTHROP PATRICK J

(Last) (First) (Middle)
C/O PERSONALIS, INC.
1330 O'BRIEN DRIVE

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/19/2019
3. Issuer Name and Ticker or Trading Symbol
Personalis, Inc. [ PSNL ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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 13,541 I See footnote(1)
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) (2) 09/02/2025 Common Stock 23,958 5.28 D
Stock Option (right to buy) (3) 04/25/2028 Common Stock 12,500 3.8 D
Stock Option (right to buy) (4) 05/01/2029 Common Stock 15,000 13.2 D
Explanation of Responses:
1. The shares are held of record by Patrick Balthrop & Mariteres Balthrop Trust, of which the Reporting Person and the Reporting Person's spouse serve as co-trustees.
2. The shares subject to the option are fully vested and exercisable.
3. 1/12 of the shares subject to the option vested on August 17, 2018, and 1/12 of the shares vest monthly thereafter.
4. 1/24 of the shares subject to the option will vest on September 17, 2019, and 1/24 of the shares will vest monthly thereafter.
Remarks:
/s/ Peter Mandel, Attorney-in-Fact 06/19/2019
** 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).
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.