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