0001104659-21-094519.txt : 20210721 0001104659-21-094519.hdr.sgml : 20210721 20210721180156 ACCESSION NUMBER: 0001104659-21-094519 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210719 FILED AS OF DATE: 20210721 DATE AS OF CHANGE: 20210721 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CRITCHFIELD GREGORY C CENTRAL INDEX KEY: 0001191080 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40606 FILM NUMBER: 211105450 MAIL ADDRESS: STREET 1: 320 WAKARA WAY CITY: SALT LAKE CITY STATE: UT ZIP: 84108 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 4 1 tm2122781-3_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2021-07-19 0 0001534969 SERA PROGNOSTICS, INC. SERA 0001191080 CRITCHFIELD GREGORY C C/O SERA PROGNOSTICS, INC. 2749 EAST PARLEYS WAY, SUITE 200 SALT LAKE CITY UT 84109 1 1 0 0 Chief Executive Officer Class A Common Stock 2021-07-19 4 C 0 34383 A 744355 D Class A Common Stock 2021-07-19 4 C 0 5253 A 749608 D Class A Common Stock 2021-07-19 4 C 0 11880 A 761488 D Class A Common Stock 2021-07-19 4 C 0 4727 A 766215 D Class A Common Stock 2021-07-19 4 C 0 28730 A 794945 D Series A-2 Preferred Stock 2021-07-19 4 C 0 34383 0 D Class A Common Stock 34383 0 D Series B-1 Preferred Stock 2021-07-19 4 C 0 5253 0 D Class A Common Stock 5253 0 D Series B-2 Preferred Stock 2021-07-19 4 C 0 11880 0 D Class A Common Stock 11880 0 D Series C-1 Preferred Stock 2021-07-19 4 C 0 4727 0 D Class A Common Stock 4727 0 D Series D Preferred Stock 2021-07-19 4 C 0 28730 0 D Class A Common Stock 28730 0 D The Issuer's Series A-2 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 $5.20 per share. The Series A-2 Preferred Stock has no expiration date. Includes 630,832 shares of Class A Common Stock directly held by The Gregory C. Critchfield & Trust. Dr. Critchfield is a Trustee of the Gregory C. Critchfield & Trust. Dr. Critchfield, in such capacity, may be deemed to indriectly beneficially own the securities owned by the trust except to the extent of his pecuniary interest therein, if any. The Issuer's Series B-1 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 $5.20 per share. The Series B-1 Preferred Stock has no expiration date. The Issuer's Series B-2 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 $8.32 per share. The Series B-2 Preferred Stock has no expiration date. The Issuer's Series C-1 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 $12.37 per share. The Series C-1 Preferred Stock has no expiration date. 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. The shares of preferred stock automatically converted 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, which became effective on July 19, 2021. /s/ Nishanti Dharia, Attorney-in-fact 2021-07-21