0001209191-22-034752.txt : 20220607 0001209191-22-034752.hdr.sgml : 20220607 20220607073014 ACCESSION NUMBER: 0001209191-22-034752 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220531 FILED AS OF DATE: 20220607 DATE AS OF CHANGE: 20220607 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: 22999817 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2022-05-31 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 2022-05-31 4 M 0 60668 0.2108 A 159957 D Common Stock 2022-05-31 4 M 0 34271 0.235 A 194228 D Common Stock 2022-05-31 4 M 0 60000 0.63 A 254228 D Common Stock 2022-05-31 4 G 0 154939 0.00 D 99289 D Common Stock 251933 I By The Pellini Family Trust Stock Option (Right to Buy) 0.2108 2022-05-31 4 M 0 60668 0.00 D 2017-09-15 2027-09-14 Common Stock 60668 0 D Stock Option (Right to Buy) 0.235 2022-05-31 4 M 0 34271 0.00 D 2018-12-12 2028-12-11 Common Stock 34271 0 D Stock Option (Right to Buy) 0.63 2022-05-31 4 M 0 60000 0.00 D 2019-12-17 2029-12-16 Common Stock 60000 0 D Immediately upon exercise of the Reporting Person's options, the Reporting Person transferred his shares as a gift 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 2022-06-07