Sec Form 3 Filing - Telegraph Hill Partners IV, L.P. @ Alpha Teknova, Inc. - 2021-06-24

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FORM 3
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
Telegraph Hill Partners IV, L.P.
2. Issuer Name and Ticker or Trading Symbol
Alpha Teknova, Inc. [ TKNO]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
360 POST STREET, SUITE 601
3. Date of Earliest Transaction (MM/DD/YY)
06/24/2021
(Street)
SAN FRANCISCO, CA94108
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ 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
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 A Convertible Preferred Stock ( 1 ) 01/14/2019 ( 1 ) Common Stock 14,941,823 I See Footnote ( 2 )
Series A Convertible Preferred Stock ( 1 ) 01/14/2019 ( 1 ) Common Stock 2,570,862 I See Footnote ( 3 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Telegraph Hill Partners IV, L.P.
360 POST STREET, SUITE 601
SAN FRANCISCO, CA94108
X
THP IV Affiliates Fund, LLC
360 POST STREET, SUITE 601
SAN FRANCISCO, CA94108
X
Telegraph Hill Partners IV Investment Management LLC
360 POST STREET, SUITE 601
SAN FRANCISCO, CA94108
X
Telegraph Hill Partners Management Company, LLC
360 POST STREET, SUITE 601
SAN FRANCISCO, CA94108
X
Signatures
Telegraph Hill Partners IV, L.P., By: Telegraph Hill Partners IV Investment Management, LLC, its general parter, By: Telegraph Hill Partners Management Company, LLC, its manager, By: /s/ Jeanette Welsh, Title: Partner 06/23/2021
Signature of Reporting Person Date
THP IV Affiliates Fund, LLC, By: Telegraph Hill Partners IV Investment Management, LLC, its manager, By: Telegraph Hill Partners Management Company, LLC, its manager, By: /s/ Jeanette Welsh, Title: Partner 06/23/2021
Signature of Reporting Person Date
Telegraph Hill Partners IV Investment Management, LLC, By: Telegraph Hill Partners Management Company, LLC, its manager, By: /s/ Jeanette Welsh, Title: Partner 06/23/2021
Signature of Reporting Person Date
Telegraph Hill Partners Management Company, LLC, By: /s/ Jeanette Welsh, Title: Partner 06/23/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The Series A Convertible Preferred Stock is convertible at any time, at the holder's election, and has no expiration date. The Series A Convertible Preferred Stock will convert automatically upon the issuer's consummation of a qualifying initial public offering.
( 2 )Shares held directly by Telegraph Hill Partners IV, L.P ("THP IV"). Telegraph Hill Partners IV Investment Management, LLC ("THP IM") is the general partner of THP IV. Telegraph Hill Partners Management Company, LLC ("THPMC") is the manager of THP IM. As such, THP IM and THPMC may be deemed to have beneficial ownership of the shares held by THP IV.
( 3 )Shares held directly by THP IV Affiliates Fund, LLC ("THP IV AFF"). THP IM is the manager of of THP IV AFF. THPMC is the manager of THP IM. As such, THP IM and THPMC may be deemed to have beneficial ownership of the shares held by THP IV AFF.

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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