Genoptix Inc - Initial Statement of Beneficial Ownership
October 29 2007 - 7:54PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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January 31, 2008
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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
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MINOCHERHOMJEE ARDA PHD
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2. Date of Event Requiring Statement (MM/DD/YYYY)
10/29/2007
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3. Issuer Name
and
Ticker or Trading Symbol
GENOPTIX INC [GXDX]
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(Last)
(First)
(Middle)
303 WEST MADISON STREET, SUITE 2500
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__
X
__ Director
___
X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
CHICAGO, IL 60606
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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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 Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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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 of Derivative Security: 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
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Expiration Date
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Title
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Amount or Number of Shares
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Series 1-D Preferred Stock
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(1)
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(1)
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Common Stock
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1328241
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(1)
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I
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See footnote
(2)
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Series 1-D Preferred Stock
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(1)
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(1)
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Common Stock
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1328241
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(1)
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I
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See footnote
(3)
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Explanation of Responses:
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(
1)
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The Series 1-D Preferred Stock has no expiration date and is convertible at any time at the option of the holder and will automatically convert upon the closing of the Issuer's initial public offering, at a conversion ratio of one share of Common Stock for every 4.75 shares of Series 1-D Preferred Stock, for no additional consideration.
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(
2)
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Represents securities held by Chicago Growth Partners, L.P. The Reporting Person may be deemed to have shared voting and dispositive power over the shares beneficially owned by Chicago Growth Partners, LP. but disclaims such beneficial ownership, except to the extent of his pecuniary interest therein, if any.
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(
3)
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Represents securities held by William Blair Capital Partners VII, L.P. and William Blair Capital Partners VII QP, L.P. The Reporting Person may be deemed to have shared voting and dispositive power over the shares beneficially owned by William Blair Capital Partners VII, L.P. and William Blair Capital Partners VII QP, L.P. but disclaims such beneficial ownership, except to the extent of his pecuniary interest therein, if any.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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MINOCHERHOMJEE ARDA PHD
303 WEST MADISON STREET, SUITE 2500
CHICAGO, IL 60606
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X
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X
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Signatures
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/s/ Arda M. Minocherhomjee, Ph.D.
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10/29/2007
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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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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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 control number.
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