0001209191-22-008986.txt : 20220211 0001209191-22-008986.hdr.sgml : 20220211 20220211181232 ACCESSION NUMBER: 0001209191-22-008986 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211231 FILED AS OF DATE: 20220211 DATE AS OF CHANGE: 20220211 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Spaventa Andrew CENTRAL INDEX KEY: 0001859701 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40443 FILM NUMBER: 22623389 MAIL ADDRESS: STREET 1: 10931 N. TORREY PINES ROAD, SUITE 100 CITY: LA JOLLA STATE: CA ZIP: 92037 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 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2021-12-31 0 0 0 0001850906 Singular Genomics Systems, Inc. OMIC 0001859701 Spaventa Andrew 10931 N. TORREY PINES ROAD SUITE#100 LA JOLLA CA 92037 1 1 0 0 Chief Executive Officer Common Stock 2021-11-04 5 G 0 200000 0.00 D 4413571 I By The Andrew K. Spaventa Living Trust dated April 9, 2014 Common Stock 173144 I By Axon Holdings, LLC This transaction represents a gift by the Reporting Person. The shares are held directly by Axon Holdings, LLC. The managing member of Axon Holdings, LLC is Axon Managers, LLC. The Reporting Person is a managing member of Axon Managers, LLC and may be deemed to have shared voting and investment power over the shares held by Axon Holdings, LLC. The Reporting Person disclaims beneficial ownership of the shares except to the extent of his pecuniary interest therein. /s/ Dalen Meeter, Attorney-in-Fact 2022-02-11