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