SEC FORM
3
SEC Form 3
| 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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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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)
08/04/2023
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3. Issuer Name and Ticker or Trading Symbol
Singular Genomics Systems, Inc.
[ OMIC ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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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)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
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| No securities are beneficially owned. |
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/s/ Dalen Meeter, Attorney-in-Fact |
08/08/2023 |
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** 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. |
POWER OF ATTORNEY
KNOW ALL BY THESE PRESENTS, the undersigned hereby constitutes and appoints each
of
Dalen Meeter and Eric Stier, signing singly, and with full power of
substitution, the
undersigned's true and lawful attorney-in-fact to:
(1) execute for and on behalf of the undersigned a Form ID Application, if
required, and submit
the same to the United States Securities and Exchange Commission;
(2) execute for and on behalf of the undersigned, in the undersigned's capacity
as an officer
and/or director of Singular Genomics Systems, Inc. (the "Company") or as a
holder of 10 percent
or more of the Company's securities, Forms 3, 4 and 5, and any amendments
thereto, in
accordance with Section 16 of the Securities Exchange Act of 1934, as amended,
and the rules
thereunder and, if necessary, such forms or similar reports required by state or
foreign regulators
in jurisdictions in which the Company operates;
(3) do and perform any and all acts for and on behalf of the undersigned that
may be necessary or
desirable to complete and execute any such Form 3, 4 or 5 or similar form or
report required by
state or foreign regulators, and any amendments thereto, and file such form or
report with the
United States Securities and Exchange Commission and any stock exchange or
similar authority
or appropriate state or foreign regulator; and
(3) take any other action of any type whatsoever in connection with the
foregoing that, in the
opinion of such attorney-in-fact, may be of benefit to, in the best interest of
or legally required to
be done by the undersigned, it being understood that the documents executed by
such attorney-
in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be
in such form and
shall contain such terms and conditions as such attorney-in-fact may approve in
such attorney-in-
fact's discretion.
The undersigned acknowledges that:
(1) this Power of Attorney authorizes, but does not require, such
attorney-in-fact to act in their
discretion on information provided to such attorney-in-fact without independent
verification of
such information;
(2) any documents prepared and or executed by such attorney-in-fact on behalf of
the
undersigned pursuant to this Power of Attorney will be in such form and will
contain such
information and disclosure as such attorney-in-fact, in his or her discretion,
deems necessary or
desirable;
(3) neither the Company nor such attorney-in-fact assumes (i) any liability for
the
undersigned's responsibility to comply with the requirement of the Exchange Act,
(ii) any
liability of the undersigned for any failure to comply with such requirements,
or (iii) any
obligation or liability of the undersigned for profit disgorgement under Section
16(b) of the
Exchange Act; and
(4) this Power of Attorney does not relieve the undersigned from responsibility
for
compliance with the undersigned's obligations under the Exchange Act, including
without
limitation the reporting requirements under Section 16 of the Exchange Act.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and
perform any and every act and thing whatsoever requisite, necessary or proper to
be done in the
exercise of any of the rights and powers herein granted, as fully to all intents
and purposes as the
undersigned might or could do if personally present, with full power of
substitution or
revocation, hereby ratifying and confirming all that such attorney-in-fact, or
such attorney-in-
fact's substitute or substitutes, shall lawfully do or cause to be done by
virtue of this Power of
Attorney and the rights and powers herein granted. The undersigned acknowledges
that the
foregoing attorneys-in-fact, in serving in such capacity at the request of the
undersigned, are not
assuming, nor is the Company assuming, any of the undersigned's responsibilities
to comply
with Section 16 of the Securities Exchange Act of 1934, as amended, and the
rules thereunder.
This Power of Attorney may be filed with the SEC as a confirming statement of
the authority
granted herein.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer
required to file Forms 3, 4, and 5 with respect to the undersigned's holdings of
and transactions
in securities issued by the Company, unless earlier revoked by the undersigned
in a signed
writing delivered to the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as
of this fourth day of August, 2023.
/s/ Marcia Eisenberg, Phd
Signature
Marcia Eisenberg, Phd
Print Name
