| 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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 07/14/2021 |
3. Issuer Name and Ticker or Trading Symbol
SERA PROGNOSTICS, INC. [ SERA ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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| 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) |
| Class A Common Stock | 79,140 | D | |
| Class A Common Stock | 630,832 | I | Held by The Gregory C. Critchfield & Trust(1) |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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| 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-2 Preferred Stock | (2) | (3) | Class A Common Stock | 34,383 | $5.2(4) | D | |
| Series B-1 Preferred Stock | (2) | (3) | Class A Common Stock | 5,253 | $5.2(5) | D | |
| Series B-2 Preferred Stock | (2) | (3) | Class A Common Stock | 11,880 | $8.32(6) | D | |
| Series C-1 Preferred Stock | (2) | (3) | Class A Common Stock | 4,727 | $12.37(7) | D | |
| Series D Preferred Stock | (2) | (3) | Class A Common Stock | 28,730 | $9.02(8) | D | |
| Stock Option (right to buy) | (9) | 05/18/2027 | Class A Common Stock | 300,610 | $1.98 | D | |
| Stock Option (right to buy) | (9) | 02/27/2030 | Class A Common Stock | 462,338 | $1.77 | D | |
| Stock Option (right to buy) | (9) | 03/08/2031 | Class A Common Stock | 98,330 | $5.32 | D | |
| Warrant (right to buy) | (10) | 07/31/2029 | Class A Common Stock | 4,412 | $9.02 | I | Held by the Gregory C. Critchfield & Trust(1) |
| Warrant (right to buy) | (10) | 07/31/2029 | Class A Common Stock | 4,412 | $10.83 | I | Held by the Gregory C. Critchfield & Trust(1) |
| Explanation of Responses: |
| 1. Dr. Critchfield is a Trustee of the Gregory C. Critchfield & Trust. Dr. Critchfield, in such capacity, may be deemed to indriectly beneficially own the securities owned by the trust except to the extent of his pecuniary interest therein, if any. |
| 2. The shares of preferred stock will automatically convert into the Issuer's Class A Common Stock in accordance with the Issuer's Restated Certificate of Incorporation, as amended, immediately upon completion of the Issuer's initial public offering. |
| 3. Not applicable |
| 4. The Issuer's Series A-2 Preferred Stock is convertible at the option of a holder at any time into shares of the Issuer's Class A Common Stock at a conversion price, as adjusted to reflect the Issuer's recent 1-for-0.481 reverse stock split, of $5.20 per share. The Series A-2 Preferred Stock has no expiration date. |
| 5. The Issuer's Series B-1 Preferred Stock is convertible at the option of a holder at any time into shares of the Issuer's Class A Common Stock at a conversion price, as adjusted to reflect the Issuer's recent 1-for-0.481 reverse stock split, of $5.20 per share. The Series B-1 Preferred Stock has no expiration date. |
| 6. The Issuer's Series B-2 Preferred Stock is convertible at the option of a holder at any time into shares of the Issuer's Class A Common Stock at a conversion price, as adjusted to reflect the Issuer's recent 1-for-0.481 reverse stock split, of $8.32 per share. The Series B-2 Preferred Stock has no expiration date. |
| 7. The Issuer's Series C-1 Preferred Stock is convertible at the option of a holder at any time into shares of the Issuer's Class A Common Stock at a conversion price, as adjusted to reflect the Issuer's recent 1-for-0.481 reverse stock split, of $12.37 per share. The Series C-1 Preferred Stock has no expiration date. |
| 8. The Issuer's Series D Preferred Stock is convertible at the option of a holder at any time into shares of the Issuer's Class A Common Stock at a conversion price, as adjusted to reflect the Issuer's recent 1-for-0.481 reverse stock split, of $9.02 per share. The Series D Preferred Stock has no expiration date. |
| 9. These stock options vest over four years as follows: 1/48 of the original grant amount vests in monthly installments for four years following the grant date. |
| 10. Immediately exercisable. |
| Remarks: |
| Exhibits 24.1 - Power of Attorney |
| /s/ Nishanti Dharia, Attorney-in-fact | 07/14/2021 | |
| ** 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. | ||