0001209191-21-037022.txt : 20210601 0001209191-21-037022.hdr.sgml : 20210601 20210601215009 ACCESSION NUMBER: 0001209191-21-037022 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210601 FILED AS OF DATE: 20210601 DATE AS OF CHANGE: 20210601 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Spaventa Andrew CENTRAL INDEX KEY: 0001859701 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40443 FILM NUMBER: 21987554 MAIL ADDRESS: STREET 1: 10931 N. TORREY PINES ROAD, SUITE 100 CITY: LA JOLLA STATE: CA ZIP: 92037 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Singular Genomics Systems, Inc. CENTRAL INDEX KEY: 0001850906 STANDARD INDUSTRIAL CLASSIFICATION: LABORATORY ANALYTICAL INSTRUMENTS [3826] IRS NUMBER: 812948451 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 10931 N. TORREY PINES ROAD, SUITE #100 CITY: LA JOLLA STATE: CA ZIP: 92037 BUSINESS PHONE: (858) 333-7830 MAIL ADDRESS: STREET 1: 10931 N. TORREY PINES ROAD, SUITE #100 CITY: LA JOLLA STATE: CA ZIP: 92037 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-06-01 0 0001850906 Singular Genomics Systems, Inc. OMIC 0001859701 Spaventa Andrew 10931 N. TORREY PINES ROAD SUITE#100 LA JOLLA CA 92037 1 1 0 0 Chief Executive Officer Common Stock 2021-06-01 4 C 0 715884 A 715884 I By Axon Holdings, LLC Common Stock 2021-06-01 4 C 0 173144 17.60 A 889028 I By Axon Holdings, LLC Common Stock 4613571 I By The Andrew K. Spaventa Living Trust dated April 9, 2014 Series Seed Preferred Stock 2021-06-01 4 C 0 362266 D Common Stock 362266 0 I By Axon Holdings, LLC Series A Preferred Stock 2021-06-01 4 C 0 201155 D Common Stock 201155 0 I By Axon Holdings, LLC Series B Preferred Stock 2021-06-01 4 C 0 152463 D Common Stock 152463 0 I By Axon Holdings, LLC Convertible Promissory Note 2021-06-01 4 C 0 173144 D Common Stock 173144 0 I By Axon Holdings, LLC Immediately prior to the closing of the Issuer's initial public offering ("IPO"), each share of the Series Seed Preferred Stock, Series A Preferred Stock, and Series B Preferred Stock (collectively, the "Preferred Stock") automatically converted into shares of the Issuer's common stock, par value $0.0001 per share, on a one-for-one basis. The shares of Preferred Stock had no expiration date. The shares are held directly by Axon Holdings, LLC. The managing member of Axon Holdings, LLC is Axon Managers, LLC. The Reporting Person is a managing member of Axon Managers, LLC. and may be deemed to have shared voting and investment power over the shares held by Axon Holdings, LLC. The Reporting Person disclaims beneficial ownership of the shares except to the extent of his pecuniary interest therein. The holdings of Axon Holdings, LLC depicted above reflect applicable transfers and related transactions prior to the IPO from Axon Ventures X, LLC. Immediately prior to the closing of the Issuer's IPO, the Convertible Note automatically converted into shares of the Issuer's common stock at a conversion price of $17.60 per share. The maturity date of the Convertible Note is the earliest to occur of (1) February 25, 2023 and (2) an Event of Default as defined in the related Note Purchase Agreement. /s/ Dalen Meeter, Attorney-in-Fact 2021-06-01