0001493152-24-025322.txt : 20240626
0001493152-24-025322.hdr.sgml : 20240626
20240626191752
ACCESSION NUMBER: 0001493152-24-025322
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240617
FILED AS OF DATE: 20240626
DATE AS OF CHANGE: 20240626
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KEYWELL BRADLEY A
CENTRAL INDEX KEY: 0001114238
ORGANIZATION NAME:
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-42130
FILM NUMBER: 241074908
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Tempus AI, Inc.
CENTRAL INDEX KEY: 0001717115
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING, DATA PROCESSING, ETC. [7370]
ORGANIZATION NAME: 06 Technology
IRS NUMBER: 474903308
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 600 WEST CHICAGO AVENUE
STREET 2: SUITE 510
CITY: CHICAGO
STATE: IL
ZIP: 60654
BUSINESS PHONE: 800-976-5448
MAIL ADDRESS:
STREET 1: 600 WEST CHICAGO AVENUE
STREET 2: SUITE 510
CITY: CHICAGO
STATE: IL
ZIP: 60654
FORMER COMPANY:
FORMER CONFORMED NAME: Tempus Labs, Inc.
DATE OF NAME CHANGE: 20170915
4
1
ownership.xml
X0508
4
2024-06-17
0
0001717115
Tempus AI, Inc.
TEM
0001114238
KEYWELL BRADLEY A
4603 FRANKLIN PIKE
NASHVILLE,
TN
37220
0
0
1
0
0
Class A Common Stock
2024-06-17
4
C
0
2169419
A
16560249
I
By BK TL21 LLC
Series A Preferred Stock
2024-06-17
4
C
0
1109189
0
D
Class A Common Stock
1109189
0
I
By BK TL21 LLC
Series B-1 Preferred Stock
2024-06-17
4
C
0
499964
0
D
Class A Common Stock
499964
0
I
By BK TL21 LLC
Series B-2 Preferred Stock
2024-06-17
4
C
0
166717
0
D
Class A Common Stock
166717
0
I
By BK TL21 LLC
Series C Preferred Stock
2024-06-17
4
C
0
314338
0
D
Class A Common Stock
314338
0
I
By BK TL21 LLC
Series D Preferred Stock
2024-06-17
4
C
0
63653
0
D
Class A Common Stock
63653
0
I
By BK TL21 LLC
Series G Preferred Stock
2024-06-17
4
C
0
15558
0
D
Class A Common Stock
15558
0
I
By BK TL21 LLC
Each share of Series A Preferred Stock, Series B-1 Preferred Stock, Series B-2 Preferred Stock, Series C Preferred Stock, Series D Preferred Stock and Series G Preferred Stock (collectively, the "Preferred Stock") was convertible at any time, at the holder's election, into Class A Common Stock, on a one-for-one basis, had no expiration date and automatically converted into shares of Class A Common Stock upon the closing of the Issuer's initial public offering.
This amount includes an additional 15,830 shares acquired by the Reporting Person on June 17, 2024 in connection with the conversion of the Preferred Stock into Class A Common Stock upon the closing of the Issuer's initial public offering, pursuant to which the Issuer paid accrued and unpaid dividends on such shares of Preferred Stock in shares of Class A Common Stock. This amount was also reflected in the Reporting Person's Form 3 filing on June 20, 2024. The issuance of such shares of Class A Common Stock qualifies for the exemption from Section 16 of the Securities Exchange Act pursuant to Rule 16a-9.
The Reporting Person is the sole manager and the sole member of BK TL21 LLC.
/s/ Bradley A. Keywell
2024-06-26