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 |
|
1. Name and Address of Reporting Person*
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year) 06/24/2021 |
3. Issuer Name and Ticker or Trading Symbol
Alpha Teknova, Inc. [ TKNO ] |
|||||||||||||
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
5. If Amendment, Date of Original Filed
(Month/Day/Year) |
||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
|
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) |
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 Convertible Preferred Stock | 01/14/2019 | (1) | Common Stock | 14,941,823 | (1) | I | See Footnote(2) |
Series A Convertible Preferred Stock | 01/14/2019 | (1) | Common Stock | 2,570,862 | (1) | I | See Footnote(3) |
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
| ||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
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. |
Remarks: |
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 | |
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 | |
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 | |
Telegraph Hill Partners Management Company, LLC, By: /s/ Jeanette Welsh, Title: Partner | 06/23/2021 | |
** 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. |