0001104659-21-094472.txt : 20210721 0001104659-21-094472.hdr.sgml : 20210721 20210721170448 ACCESSION NUMBER: 0001104659-21-094472 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210714 FILED AS OF DATE: 20210721 DATE AS OF CHANGE: 20210721 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BXHCP SP II, LLC CENTRAL INDEX KEY: 0001804589 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40606 FILM NUMBER: 211105174 BUSINESS ADDRESS: STREET 1: 135 E 57TH STREET STREET 2: 23RD FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: (646) 688-1617 MAIL ADDRESS: STREET 1: 135 E 57TH STREET STREET 2: 23RD FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Blue Ox Healthcare Partners SP, LLC CENTRAL INDEX KEY: 0001785138 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40606 FILM NUMBER: 211105172 BUSINESS ADDRESS: STREET 1: 135 E. 57TH STREET, 23RD FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 646.688.1617 MAIL ADDRESS: STREET 1: 135 E. 57TH STREET, 23RD FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Blue Ox Healthcare Partners, LLC CENTRAL INDEX KEY: 0001873840 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40606 FILM NUMBER: 211105175 BUSINESS ADDRESS: STREET 1: 239 DAWSON ROAD CITY: HILLSIDE STATE: NY ZIP: 12529 BUSINESS PHONE: 646.688.1617 MAIL ADDRESS: STREET 1: 239 DAWSON ROAD CITY: HILLSIDE STATE: NY ZIP: 12529 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BXHCP SP III, LLC CENTRAL INDEX KEY: 0001862000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40606 FILM NUMBER: 211105173 BUSINESS ADDRESS: STREET 1: 229 DAWSON ROAD CITY: HILLSDALE STATE: NY ZIP: 12529 BUSINESS PHONE: (646) 688-1617 MAIL ADDRESS: STREET 1: 229 DAWSON ROAD CITY: HILLSDALE STATE: NY ZIP: 12529 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SERA PROGNOSTICS, INC. CENTRAL INDEX KEY: 0001534969 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 261911522 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2749 E. PARLEYS WAY STREET 2: SUITE 200 CITY: SALT LAKE CITY STATE: UT ZIP: 84109 BUSINESS PHONE: (801) 990-0520 MAIL ADDRESS: STREET 1: 2749 E. PARLEYS WAY STREET 2: SUITE 200 CITY: SALT LAKE CITY STATE: UT ZIP: 84109 3 1 tm2122872-1_3seq1.xml OWNERSHIP DOCUMENT X0206 3 2021-07-14 0 0001534969 SERA PROGNOSTICS, INC. SERA 0001873840 Blue Ox Healthcare Partners, LLC C/O SERA PROGNOSTICS, INC. 2749 EAST PARLEYS WAY, SUITE 200 SALT LAKE CITY UT 84109 0 0 1 0 0001804589 BXHCP SP II, LLC C/O SERA PROGNOSTICS, INC. 2749 EAST PARLEYS WAY, SUITE 200 SALT LAKE CITY UT 84109 0 0 1 0 0001862000 BXHCP SP III, LLC C/O SERA PROGNOSTICS, INC. 2749 EAST PARLEYS WAY, SUITE 200 SALT LAKE CITY UT 84109 0 0 1 0 0001785138 Blue Ox Healthcare Partners SP, LLC C/O SERA PROGNOSTICS, INC. 2749 EAST PARLEYS WAY, SUITE 200 SALT LAKE CITY UT 84109 0 0 1 0 Series D Preferred Stock 9.02 Class A Common Stock 1515595 I By Blue Ox Healthcare Partners SP, LLC Series D Preferred Stock 9.02 Class A Common Stock 1075047 I By BXHCP SP II, LLC Series E Preferred Stock 12.45 Class A Common Stock 1204508 I By BXHCP SP III, LLC Warrant (right to buy) 9.02 2029-07-31 Class A Common Stock 378897 I By Blue Ox Healthcare Partners SP, LLC Warrant (right to buy) 10.83 2029-07-31 Class A Common Stock 378897 I By Blue Ox Healthcare Partners SP, LLC The shares of preferred stock will automatically convert into the Issuer's Class A Common Stock in accordance with the Issuer's Restated Certificate of Incorporation, as amended, immediately upon completion of the Issuer's initial public offering. Not applicable The Issuer's Series D Preferred Stock is convertible at the option of a holder at any time into shares of the Issuer's Class A Common Stock at a conversion price, as adjusted to reflect the Issuer's recent 1-for-0.481 reverse stock split, of $9.02 per share. The Series D Preferred Stock has no expiration date. Blue Ox Healthcare Partners, LLC is the manager of each of Blue Ox Healthcare Partners SP, LLC, BXHCP SP II, LLC, and BXHCP SP III, LLC, and may be deemed to have voting, investment and dispositive power with respect to the shares held by Blue Ox Healthcare Partners SP, LLC, BXHCP SP II, LLC, and BXHCP SP III, LLC. Charles D. Kennedy MD, Oded Levy, and John A. Neczesny, managing partners of Blue Ox Healthcare Partners, LLC, each may be deemed to share voting, investment and dispositive power with respect to these shares. The Issuer's Series E Preferred Stock is convertible at the option of a holder at any time into shares of the Issuer's Class A Common Stock at a conversion price, as adjusted to reflect the Issuer's recent 1-for-0.481 reverse stock split, of $12.45 per share. The Series E Preferred Stock has no expiration date. Immediately exercisable. Blue Ox Healthcare Partners, LLC /s/ John A. Neczesny, Secretary John A. Neczesny, Secretary 2021-07-21 Blue Ox Healthcare Partners SP, LLC /s/ John A. Neczesny, Secretary John A. Neczesny, Secretary 2021-07-21 BXHCP SP II, LLC /s/ John A. Neczesny, Secretary John A. Neczesny, Secretary 2021-07-21 BXHCP SP III, LLC /s/ John A. Neczesny, Secretary John A. Neczesny, Secretary 2021-07-21