Erik T. Engelson Form 3 Lucira Health / Erik T. Engelson ownership change

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^*

Engelson Erik T.

(Last) (First) (Middle)

1412 62ND STREET

(Street)

EMERYVILLE CA 94608

(City) (State) (Zip)

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)

X	Director	10% Owner
X	Officer (give title below)	Other (specify below)
President and Chief Executive

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

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)
Common Stock	46,400	I	See footnote(1)
Common Stock	191,705	I	See footnote(2)

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
Stock Option (right to buy)	(3)	04/09/2029	Common Stock	574,667	0.82	D
Stock Option (right to buy)	(3)	09/24/2030	Common Stock	432,753	2.2	D
Series C Preferred Stock	(4)	(4)	Common Stock	23,282	(4)	I	See footnote(5)

Explanation of Responses:

1. The shares are held by the Elisabeth North Keuchler Engelson Trust, dated January 17, 2001, for which Mr. Engelson serves as trustee.

2. The shares are held by Epic Pacific, LLC, of which Mr. Engelson is a Member. Mr. Engelson disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.

3. The shares subject to the option are immediately exercisable. 1/48th of the shares subject to the option shall vest monthly over the four years from the vesting commencement date.

4. Each share of 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, for no additional consideration. The shares of Preferred Stock have no expiration date.

5. The shares are held by Pacific Premier Trust Custodian FBO Erik Engelson IRA, for which Mr. Engelson serves as trustee.

Remarks:

	/s/ Dan George, Attorney-in-Fact for Erik T. Engelson	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).
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