0001209191-23-005999.txt : 20230201 0001209191-23-005999.hdr.sgml : 20230201 20230201184925 ACCESSION NUMBER: 0001209191-23-005999 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221231 FILED AS OF DATE: 20230201 DATE AS OF CHANGE: 20230201 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Pellini Michael J CENTRAL INDEX KEY: 0001402017 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40443 FILM NUMBER: 23578244 MAIL ADDRESS: STREET 1: 222 DUTTON MILL RD CITY: WILLISTOWN STATE: PA ZIP: 19380 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Singular Genomics Systems, Inc. CENTRAL INDEX KEY: 0001850906 STANDARD INDUSTRIAL CLASSIFICATION: LABORATORY ANALYTICAL INSTRUMENTS [3826] IRS NUMBER: 812948451 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3010 SCIENCE PARK ROAD CITY: SAN DIEGO STATE: CA ZIP: 92121 BUSINESS PHONE: (858) 333-7830 MAIL ADDRESS: STREET 1: 3010 SCIENCE PARK ROAD CITY: SAN DIEGO STATE: CA ZIP: 92121 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2022-12-31 0 0 0 0001850906 Singular Genomics Systems, Inc. OMIC 0001402017 Pellini Michael J 3010 SCIENCE PARK ROAD SAN DIEGO CA 92121 1 0 0 0 Common Stock 2022-02-10 5 G 0 72455 0.00 D 26834 D Common Stock 324388 I By The Pellini Family Trust This transaction represents the gift of shares by the Reporting Person to The Pellini Family Trust. The Reporting Person is the trustee of The Pellini Family Trust and has voting and dispositive power with respect to these shares. /s/ Dalen Meeter, Attorney-in-Fact 2023-02-01