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