0001209191-21-012522.txt : 20210219 0001209191-21-012522.hdr.sgml : 20210219 20210219182113 ACCESSION NUMBER: 0001209191-21-012522 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210217 FILED AS OF DATE: 20210219 DATE AS OF CHANGE: 20210219 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Popovits Kimberly J CENTRAL INDEX KEY: 0001333482 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40047 FILM NUMBER: 21657652 MAIL ADDRESS: STREET 1: 301 PENOBSCOT DRIVE CITY: REDWOOD CITY STATE: CA ZIP: 94063 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Talis Biomedical Corp CENTRAL INDEX KEY: 0001584751 STANDARD INDUSTRIAL CLASSIFICATION: LABORATORY ANALYTICAL INSTRUMENTS [3826] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 230 CONSTITUTION DRIVE CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-433-3000 MAIL ADDRESS: STREET 1: 230 CONSTITUTION DRIVE CITY: MENLO PARK STATE: CA ZIP: 94025 FORMER COMPANY: FORMER CONFORMED NAME: SlipChip Corp DATE OF NAME CHANGE: 20130820 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-02-17 0 0001584751 Talis Biomedical Corp TLIS 0001333482 Popovits Kimberly J C/O TALIS BIOMEDICAL CORPORATION 230 CONSTITUTION DRIVE MENLO PARK CA 94025 1 0 0 0 Common Stock 2021-02-17 4 C 0 22041 A 25776 D Common Stock 2021-02-17 4 C 0 209790 A 209790 I By spouse Common Stock 2021-02-17 4 P 0 5300 16.00 A 215090 I By spouse Common Stock 2021-02-17 4 C 0 92057 A 92057 I By MSL FBO Kimberly J. Popovits Patrick J. Popovits TTEE U/A/D 05- 17-2010 FBO Popovits 2010 Trust Common Stock 2021-02-17 4 C 0 89968 A 182025 I By MSL FBO Kimberly J. Popovits Patrick J. Popovits TTEE U/A/D 05- 17-2010 FBO Popovits 2010 Trust Series C-1 Preferred Stock 2021-02-17 4 C 0 31519 0.00 D Common Stock 22041 0 D Series E-1 Preferred Stock 2021-02-17 4 C 0 300000 0.00 D Common Stock 209790 0 I By spouse Series E-1 Preferred Stock 2021-02-17 4 C 0 131642 0.00 D Common Stock 92057 0 I By MSL FBO Kimberly J. Popovits Patrick J. Popovits TTEE U/A/D 05- 17-2010 FBO Popovits 2010 Trust Series F-1 Preferred Stock 2021-02-17 4 C 0 128655 0.00 D Common Stock 89968 0 I By MSL FBO Kimberly J. Popovits Patrick J. Popovits TTEE U/A/D 05- 17-2010 FBO Popovits 2010 Trust Each share of Series C-1 Preferred Stock automatically converts on a 1-for-1.43 basis into Common Stock at any time at the holder's election and has no expiration date. At the closing of the Issuer's initial public offering, each share of Series C-1 Preferred stock converted into shares of Common Stock, for no additional consideration, at a rate of one share of Common Stock for each 1.43 shares of Series C-1 Preferred Stock. Each share of Series E-1 Preferred Stock automatically converts on a 1-for-1.43 basis into Common Stock at any time at the holder's election and has no expiration date. At the closing of the Issuer's initial public offering, each share of Series E-1 Preferred stock converted into shares of Common Stock, for no additional consideration, at a rate of one share of Common Stock for each 1.43 shares of Series E-1 Preferred Stock. Ms. Popovits and her spouse are trustees of the MSL FBO Kimberly J. Popovits Patrick J. Popovits TTEE U/A/D 05-17-2010 FBO Popovits 2010 Trust and share voting and dispositive power. Each share of Series F-1 Preferred Stock automatically converts on a 1-for-1.43 basis into Common Stock at any time at the holder's election and has no expiration date. At the closing of the Issuer's initial public offering, each share of Series F-1 Preferred stock converted into shares of Common Stock, for no additional consideration, at a rate of one share of Common Stock for each 1.43 shares of Series F-1 Preferred Stock. /s/ Karen E. Flick, Attorney-in-Fact for Kimberly J. Popovits 2021-02-19