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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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 02/04/2021 | 3. Issuer Name and Ticker or Trading Symbol Lucira Health, Inc. [ LHDX ] | |||||||||||||
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)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) | |||||||
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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 B Convertible Preferred | (1) | (1) | Common Stock | 32,176 | (1) | D(3)(7) | |
Series B Convertible Preferred | (1) | (1) | Common Stock | 3,754,084 | (1) | D(4)(7) | |
Series C Convertible Preferred | (1) | (1) | Common Stock | 5,173,026 | (1) | D(5)(7) | |
2020B Convertible Promissory Note | (2) | 12/11/2022 | Common Stock | 735,475 | 17 | D(6)(7) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. Each share of Series B Preferred Stock and Series C Preferred Stock (the "Preferred Stock") automatically converts on a one-for-one basis into Common Stock upon the closing of the Issuer's initial public offering (the "IPO"), for no additional consideration. The shares of Preferred Stock have no expiration date. |
2. The convertible promissory note will automatically convert into shares of the Issuer's Common Stock upon the closing of the IPO. |
3. Chad Boeding is the beneficial owner of these shares through a trust that he controls. |
4. EPQ LLC, LFLU PS ("LFLU") is the direct beneficial owner of these shares. |
5. EPQ LLC, LCOVD PS ("LCOVD") is the direct beneficial owner of these shares. |
6. EPQ LLC, LCOVD SAFE PS ("SAFE") is the direct beneficial owner of this note. |
7. The reporting persons are EPIQ Capital Group, LLC ("EPIQ"), Chad Boeding, LFLU, LCOVD, and SAFE. EPIQ is the Managing Member of LFLU, LCOVD, and SAFE. Mr. Boeding is the CEO and Manager of EPIQ. EPIQ is filing this Form 3 on behalf of the reporting persons jointly, but not as a group. EPIQ, LFLU, LCOVD, SAFE, and Mr. Boeding each disclaims beneficial ownership of the securities reported herein for purposes of Section 16 of the Securities Exchange Act of 1934 except to the extent of its or his pecuniary interest therein, if any. This report shall not be deemed an admission that any of the Reporting Persons is a beneficial owner of such securities for the purpose of Section 16 of the Exchange Act, or for any other purpose. |
EPQ LLC, LFLU PS, by EPIQ Capital Group, LLC, its Managing Member, by Chad Boeding, its CEO and Manager, /s/ Chad Boeding | 02/04/2021 | |
EPQ LLC, LCOVD PS, by EPIQ Capital Group, LLC, its Managing Member, by Chad Boeding, its CEO and Manager, /s/ Chad Boeding | 02/04/2021 | |
EPQ LLC, LCOVD SAFE PS, by EPIQ Capital Group, LLC, its Managing Member, by Chad Boeding, its CEO and Manager, /s/ Chad Boeding | 02/04/2021 | |
EPIQ Capital Group, LLC, by Chad Boeding, its CEO and Manager, /s/ Chad Boeding | 02/04/2021 | |
/s/ Chad Boeding | 02/04/2021 | |
** 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. |