Sec Form 4 Filing - Coe Brian @ Talis Biomedical Corp - 2021-02-17

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Coe Brian
2. Issuer Name and Ticker or Trading Symbol
Talis Biomedical Corp [ TLIS]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Executive Officer
(Last) (First) (Middle)
C/O TALIS BIOMEDICAL CORPORATION, 230 CONSTITUTION DRIVE
3. Date of Earliest Transaction (MM/DD/YY)
02/17/2021
(Street)
MENLO PARK, CA94025
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 02/17/2021 C 15,082 A 17,637 I By Sarles Associates LLC ( 2 )
Common Stock 02/17/2021 C 8,416 A 26,053 I By Sarles Associates LLC ( 2 )
Common Stock 02/17/2021 C 7,433 A 33,486 I By Sarles Associates LLC ( 2 )
Common Stock 58,881 D
Common Stock 3,916 I By Jason Coe Irrevocable Gift Trust ( 5 )
Common Stock 3,916 I By Lillian Coe Irrevocable Gift Trust ( 6 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series C-1 Preferred Stock ( 1 ) 02/17/2021 C 21,568 ( 1 ) ( 1 ) Common Stock 15,082 $ 0 0 I By Sarles Associates LLC ( 2 )
Series E-1 Preferred Stock ( 3 ) 02/17/2021 C 12,035 ( 3 ) ( 3 ) Common Stock 8,416 $ 0 0 I By Sarles Associates LLC ( 2 )
Series F-1 Preferred Stock ( 4 ) 02/17/2021 C 10,630 ( 4 ) ( 4 ) Common Stock 7,433 $ 0 0 I By Sarles Associates LLC ( 2 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Coe Brian
C/O TALIS BIOMEDICAL CORPORATION
230 CONSTITUTION DRIVE
MENLO PARK, CA94025
X Chief Executive Officer
Signatures
/s/ Karen E. Flick, Attorney-in-Fact for Brian Coe 02/19/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Each share of Series C-1 Preferred Stock automatically converts on a 1-for-1.43 basis into Common Stock at any time at the holder's election and has no expiration date. At the closing of the Issuer's initial public offering, each share of Series C-1 Preferred stock converted into shares of Common Stock, for no additional consideration, at a rate of one share of Common Stock for each 1.43 shares of Series C-1 Preferred Stock.
( 2 )The shares are held by a trust in which Mr. Coe's spouse and children are beneficiaries. Mr. Coe disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
( 3 )Each share of Series E-1 Preferred Stock automatically converts on a 1-for-1.43 basis into Common Stock at any time at the holder's election and has no expiration date. At the closing of the Issuer's initial public offering, each share of Series E-1 Preferred stock converted into shares of Common Stock, for no additional consideration, at a rate of one share of Common Stock for each 1.43 shares of Series E-1 Preferred Stock.
( 4 )Each share of Series F-1 Preferred Stock automatically converts on a 1-for-1.43 basis into Common Stock at any time at the holder's election and has no expiration date. At the closing of the Issuer's initial public offering, each share of Series F-1 Preferred stock converted into shares of Common Stock, for no additional consideration, at a rate of one share of Common Stock for each 1.43 shares of Series F-1 Preferred Stock.
( 5 )The shares are held by Jason Coe Irrevocable Gift Trust, for which Mr. Coe is a trustee. Mr. Coe disclaims beneficial ownership of these sharesexcept to the extent of his pecuniary interest therein.
( 6 )The shares are held by Lillian Coe Irrevocable Gift Trust, for which Mr. Coe is a trustee. Mr. Coe disclaims beneficial ownership of these sharesexcept to the extent of his pecuniary interest therein.

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 4(b)(v).
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