Michael J Pellini Form 3 Singular Genomics Systems / Michael J Pellini ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Pellini Michael J

(Last) (First) (Middle)

10931 N. TORREY PINES ROAD

SUITE#100

(Street)

LA JOLLA CA 92037

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
05/26/2021

3. Issuer Name and Ticker or Trading Symbol
Singular Genomics Systems, Inc. [ OMIC ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	72,455	D

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Series A Preferred Stock	(1)	(1)	Common Stock	96,944	0.00	I	By The Pellini Family Trust(2)
Employee Stock Option (right to buy)	(3)	09/14/2027	Common Stock	60,668	0.2108	D
Employee Stock Option (right to buy)	(4)	05/05/2031	Common Stock	27,500	22.43	D
Employee Stock Option (right to buy)	(5)	12/16/2029	Common Stock	60,000	0.63	D
Employee Stock Option (right to buy)	(6)	12/11/2028	Common Stock	34,271	0.235	D

Explanation of Responses:

1. The Series A Preferred Stock shall automatically convert into shares of the Issuer's common stock, par value $0.0001 per share (the "Common Stock"), on a one-for-one basis, immediately prior to the closing of the Issuer's initial public offering. The Series A Preferred Stock has no expiration date.

2. The Reporting Person is the trustee of The Pellini Family Trust and has voting and dispositive power with respect to these shares.

3. Option granted under the Singular Genomics Systems, Inc. 2016 Stock Plan. The option shares vest and become exercisable in 48 equal monthly installments beginning on July 21, 2017.

4. Option granted under the Singular Genomics Systems, Inc. 2016 Stock Plan. The option shares vest and become exercisable upon the earlier of the 2022 Stockholder Annual Meeting or May 5, 2022.

5. Option granted under the Singular Genomics Systems, Inc. 2016 Stock Plan. The option shares vest and become exercisable in 12 equal monthly installments beginning on January 18, 2020.

6. Option granted under the Singular Genomics Systems, Inc. 2016 Stock Plan. The option shares vest and become exercisable in 12 monthly installments beginning on January 12, 2019.

Remarks:

Exhibit 24 - Power of Attorney

	/s/ Michael J. Pellini	05/26/2021
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.