0001209191-21-037021.txt : 20210601 0001209191-21-037021.hdr.sgml : 20210601 20210601214558 ACCESSION NUMBER: 0001209191-21-037021 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210601 FILED AS OF DATE: 20210601 DATE AS OF CHANGE: 20210601 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Pellini Michael J CENTRAL INDEX KEY: 0001402017 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40443 FILM NUMBER: 21987546 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: 10931 N. TORREY PINES ROAD, SUITE #100 CITY: LA JOLLA STATE: CA ZIP: 92037 BUSINESS PHONE: (858) 333-7830 MAIL ADDRESS: STREET 1: 10931 N. TORREY PINES ROAD, SUITE #100 CITY: LA JOLLA STATE: CA ZIP: 92037 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-06-01 0 0001850906 Singular Genomics Systems, Inc. OMIC 0001402017 Pellini Michael J 10931 N. TORREY PINES ROAD SUITE#100 LA JOLLA CA 92037 1 0 0 0 Common Stock 2021-05-20 4 C 0 96944 A 96944 I By The Pellini Family Trust Common Stock 72455 D Series A Preferred Stock 2021-05-20 4 C 0 96944 D Common Stock 96944 0 I By The Pellini Family Trust Immediately prior to the closing of the Issuer's initial public offering, each share of the Series A Preferred Stock (the "Preferred Stock") automatically converted into shares of the Issuer's common stock, par value $0.0001 per share, on a one-for-one basis. The shares of Preferred Stock had no expiration date. 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 2021-06-01