Sec Form 3 Filing - Kamdar Kim P. @ Singular Genomics Systems, Inc. - 2021-05-26

Insider filing report for Changes in Beneficial Ownership
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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
Kamdar Kim P.
2. Issuer Name and Ticker or Trading Symbol
Singular Genomics Systems, Inc. [ OMIC]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O DOMAIN ASSOCIATES, LLC, 202 CARNEGIE CENTER, SUITE 104
3. Date of Earliest Transaction (MM/DD/YY)
05/26/2021
(Street)
PRINCETON, NJ08540
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 15,000 I By Domain Associates, LLC ( 1 )
Common Stock 15,000 D
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 Seed Convertible Preferred Stock ( 2 ) ( 2 ) ( 2 ) Common Stock 2,666,781 I By Domain Partners IX, L.P. ( 1 )
Series A Convertible Preferred Stock ( 2 ) ( 2 ) ( 2 ) Common Stock 1,293,243 I By Domain Partners IX, L.P. ( 1 )
Series B Convertible Preferred Stock ( 2 ) ( 2 ) ( 2 ) Common Stock 435,609 I By Domain Partners IX, L.P. ( 1 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Kamdar Kim P.
C/O DOMAIN ASSOCIATES, LLC
202 CARNEGIE CENTER, SUITE 104
PRINCETON, NJ08540
X
Signatures
/s/ Lisa A. Kraeutler, Attorney-in-Fact 05/26/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The Reporting Person is a managing member of Domain Associates, LLC and of One Partner Square Associates IX, LLC, the sole general partner of Domain Partners IX, L.P. Pursuant to Instruction 5(b)(iv) of Form 3, the Reporting Person has elected to report as indirectly beneficially owned the entire number of securities owned by each such entity, however she disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed her pecuniary interest therein and/or that are not actually distributed to her.
( 2 )All outstanding shares of convertible preferred stock will automatically convert into Common Stock upon the closing of the Issuer's initial public offering for no additional consideration. The convertible preferred stock has no expiration 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 4(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.
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