0001209191-21-012519.txt : 20210219
0001209191-21-012519.hdr.sgml : 20210219
20210219181821
ACCESSION NUMBER: 0001209191-21-012519
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210217
FILED AS OF DATE: 20210219
DATE AS OF CHANGE: 20210219
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Scott Randal W.
CENTRAL INDEX KEY: 0001337801
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40047
FILM NUMBER: 21657641
MAIL ADDRESS:
STREET 1: 171 MAIN STREET #225
CITY: LOS ALTOS
STATE: CA
ZIP: 94022
FORMER NAME:
FORMER CONFORMED NAME: Scott Randal W
DATE OF NAME CHANGE: 20050901
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Talis Biomedical Corp
CENTRAL INDEX KEY: 0001584751
STANDARD INDUSTRIAL CLASSIFICATION: LABORATORY ANALYTICAL INSTRUMENTS [3826]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 230 CONSTITUTION DRIVE
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-433-3000
MAIL ADDRESS:
STREET 1: 230 CONSTITUTION DRIVE
CITY: MENLO PARK
STATE: CA
ZIP: 94025
FORMER COMPANY:
FORMER CONFORMED NAME: SlipChip Corp
DATE OF NAME CHANGE: 20130820
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-02-17
0
0001584751
Talis Biomedical Corp
TLIS
0001337801
Scott Randal W.
C/O TALIS BIOMEDICAL CORPORATION
230 CONSTITUTION DRIVE
MENLO PARK
CA
94025
1
0
0
0
Common Stock
2021-02-17
4
C
0
752897
A
752897
I
By Thinking Bench Capital, LLC
Common Stock
2021-02-17
4
C
0
334546
A
1087443
I
By Thinking Bench Capital, LLC
Common Stock
2021-02-17
4
C
0
302621
A
1390064
I
By Thinking Bench Capital, LLC
Common Stock
2021-02-17
4
P
0
312500
16.00
A
312500
I
By OG Family Trust, u/d/t May 30, 2014
Series D-1 Preferred Stock
2021-02-17
4
C
0
1076643
0.00
D
Common Stock
752897
0
I
By Thinking Bench Capital, LLC
Series E-1 Preferred Stock
2021-02-17
4
C
0
478402
0.00
D
Common Stock
334546
0
I
By Thinking Bench Capital, LLC
Series F-1 Preferred Stock
2021-02-17
4
C
0
432749
0.00
D
Common Stock
302621
0
I
By Thinking Bench Capital, LLC
Each share of Series D-1 Preferred Stock automatically converts on a 1-for-1.43 basis into Common Stock at any time at the holder's election and has no expiration date. At the closing of the Issuer's initial public offering, each share of Series D-1 Preferred stock converted into shares of Common Stock, for no additional consideration, at a rate of one share of Common Stock for each 1.43 shares of Series D-1 Preferred Stock.
The shares are held by Thinking Bench Capital, LLC, for which Dr. Scott is the manager. The OG Family Trust, u/d/t May 30, 2014 is the sole member of Thinking Bench Capital, LLC. Dr. Scott and his spouse are trustees and share voting and dispositive power of the OG Family Trust, u/d/t May 30, 2014.
Each share of Series E-1 Preferred Stock automatically converts on a 1-for-1.43 basis into Common Stock at any time at the holder's election and has no expiration date. At the closing of the Issuer's initial public offering, each share of Series E-1 Preferred stock converted into shares of Common Stock, for no additional consideration, at a rate of one share of Common Stock for each 1.43 shares of Series E-1 Preferred Stock.
Each share of Series F-1 Preferred Stock automatically converts on a 1-for-1.43 basis into Common Stock at any time at the holder's election and has no expiration date. At the closing of the Issuer's initial public offering, each share of Series F-1 Preferred stock converted into shares of Common Stock, for no additional consideration, at a rate of one share of Common Stock for each 1.43 shares of Series F-1 Preferred Stock.
The shares are held directly by the OG Family Trust, u/d/t May 30, 2014. Dr. Scott and his spouse are trustees and share voting and dispositive power over the shares held by OG Family Trust, u/d/t May 30, 2014.
/s/ Karen E. Flick, Attorney-in-Fact for Randal Scott
2021-02-19