0001209191-20-047228.txt : 20200818 0001209191-20-047228.hdr.sgml : 20200818 20200818170159 ACCESSION NUMBER: 0001209191-20-047228 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200814 FILED AS OF DATE: 20200818 DATE AS OF CHANGE: 20200818 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lightspeed Venture Partners Select IV, L.P. CENTRAL INDEX KEY: 0001805207 STATE OF INCORPORATION: E9 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 201114460 BUSINESS ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: (650) 234-8300 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Liew Jeremy CENTRAL INDEX KEY: 0001700539 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 201114461 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mhatre Ravi CENTRAL INDEX KEY: 0001366050 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 201114462 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lightspeed General Partner Select IV, L.P. CENTRAL INDEX KEY: 0001813995 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 201114464 BUSINESS ADDRESS: STREET 1: 309 UGLAND HOUSE STREET 2: GEORGE TOWN CITY: GRAND CAYMAN STATE: E9 ZIP: KY1-1104 BUSINESS PHONE: 650-234-8300 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD STREET 2: SUITE 100 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lightspeed Ultimate General Partner Select IV, L.L.C. CENTRAL INDEX KEY: 0001813999 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 201114465 BUSINESS ADDRESS: STREET 1: 309 UGLAND HOUSE STREET 2: GEORGE TOWN CITY: GRAND CAYMAN STATE: E9 ZIP: KY1-1104 BUSINESS PHONE: 650-234-8300 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD STREET 2: SUITE 100 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Janmohamed Arif CENTRAL INDEX KEY: 0001813938 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38943 FILM NUMBER: 201114466 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD STREET 2: SUITE 100 CITY: MENLO PARK STATE: CA ZIP: 94025 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Personalis, Inc. CENTRAL INDEX KEY: 0001527753 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 275411038 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1330 O'BRIEN DRIVE CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-752-1300 MAIL ADDRESS: STREET 1: 1330 O'BRIEN DRIVE CITY: MENLO PARK STATE: CA ZIP: 94025 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2020-08-14 0 0001527753 Personalis, Inc. PSNL 0001805207 Lightspeed Venture Partners Select IV, L.P. 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 0 1 Affiliate of 10% Owner 0001700539 Liew Jeremy 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 0 1 Affiliate of 10% Owner 0001366050 Mhatre Ravi 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 0 1 Affiliate of 10% Owner 0001813995 Lightspeed General Partner Select IV, L.P. 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 0 1 Affiliate of 10% Owner 0001813999 Lightspeed Ultimate General Partner Select IV, L.L.C. 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 0 1 Affiliate of 10% Owner 0001813938 Janmohamed Arif 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 0 1 Affiliate of 10% Owner Common Stock 2020-08-14 4 P 0 1315789 19.00 A 1774240 I See footnote Common Stock 4117768 I See footnote Common Stock 1958726 I See footnote Shares held by Lightspeed Venture Partners Select IV, L.P. ("Lightspeed Select IV"). Lightspeed General Partner Select IV, L.P. ("LGP Select IV") is the general partner of Lightspeed Select IV. Lightspeed Ultimate General Partner Select IV, L.L.C. ("LUGP Select IV") is the general partner of LGP Select IV. Jeremy Liew, Ravi Mhatre and Arif Janmohamed are the managers of LUGP Select IV and share voting and dispositive power with respect to the shares held by Lightspeed Select IV. LGP Select IV, LUGP Select IV and Messrs. Liew, Mhatre and Janmohamed disclaim beneficial ownership of the shares held by Lightspeed Select IV except to the extent of their respective pecuniary interests therein. Shares held by Lightspeed Venture Partners VIII, L.P. ("Lightspeed VIII"). Lightspeed General Partner VIII, L.P ("LGP VIII") is the general partner of Lightspeed VIII. Lightspeed Ultimate General Partner VIII, Ltd. ("LUGP VIII") is the general partner of LGP VIII. Barry Eggers, Ravi Mhatre and Peter Nieh are the directors of LUGP VIII and share voting and dispositive power with respect to the shares held by Lightspeed VIII. LGP VIII, LUGP VIII and Messrs. Eggers, Mhatre and Nieh disclaim beneficial ownership of the shares held by Lightspeed VIII except to the extent of their respective pecuniary interests therein. Shares held by Lightspeed Venture Partners Select, L.P. ("Lightspeed Select"). Lightspeed General Partner Select, L.P ("LGP Select") is the general partner of Lightspeed Select. Lightspeed Ultimate General Partner Select, Ltd. ("LUGP Select") is the general partner of LGP Select. Barry Eggers, Jeremy Liew, Ravi Mhatre and Peter Nieh are the directors of LUGP Select and share voting and dispositive power with respect to the shares held by Lightspeed Select. LGP Select, LUGP Select and Messrs. Eggers, Liew, Mhatre and Nieh disclaim beneficial ownership of the shares held by Lightspeed Select except to the extent of their respective pecuniary interests therein. LIGHTSPEED VENTURE PARTNERS SELECT IV, L.P. By: Lightspeed General Partner Select IV, L.P., its general partner By: Lightspeed Ultimate General Partner Select IV, L.L.C., its general partner By: /s/ Ravi Mhatre Duly Authorized Signatory 2020-08-18 /s/ Jeremy Liew 2020-08-18 /s/ Ravi Mhatre 2020-08-18 LIGHTSPEED GENERAL PARTNER SELECT IV, L.P. By: Lightspeed Ultimate General Partner Select, L.L.C., its general partner By: /s/ Ravi Mhatre Duly Authorized Signatory 2020-08-18 LIGHTSPEED ULTIMATE GENERAL PARTNER SELECT IV, L.L.C., By: /s/ Ravi Mhatre Duly Authorized Signatory 2020-08-18 /s/ Arif Janmohamed 2020-08-18