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