Lucira Health, Inc. Form 4 — Lewis Brezoczky (Feb. 9, 2021)

Summary

In this Form 4, Kelly Lewis Brezoczky, Executive Vice President of Lucira Health, Inc. [ LHDX ], reports that 23,231 shares of Series C Preferred Stock converted into the same number of shares of Common Stock on 02/09/2021. The conversion happened automatically at the closing of the issuer's initial public offering, with no additional consideration paid. After it, the reporting person owns 23,231 common shares directly and no preferred. The signature is /s/ Dan George, Attorney-in-Fact for Kelly Lewis Brezoczky, 02/09/2021.

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Full text

SEC Form 4

FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 | OMB APPROVAL OMB Number: 3235-0287 Estimated average burden hours per response: 0.5 | OMB APPROVAL | OMB Number: 3235-0287 Estimated average burden hours per response: 0.5 | OMB Number: | 3235-0287 | Estimated average burden | hours per response: | 0.5
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person * Lewis Brezoczky Kelly (Last) (First) (Middle) 1412 62ND STREET (Street) EMERYVILLE CA 94608 (City) (State) (Zip) | Lewis Brezoczky Kelly | (Last) | (First) | (Middle) | 1412 62ND STREET | EMERYVILLE | CA | 94608 | (City) | (State) | (Zip) | 2. Issuer Name and Ticker or Trading Symbol Lucira Health, Inc. [ LHDX ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director 10% Owner X Officer (give title below) Other (specify below) Executive Vice President | Director | 10% Owner | X | Officer (give title below) | Other (specify below) | Executive Vice President
3. Date of Earliest Transaction
 (Month/Day/Year) 02/09/2021
4. 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 | X | Form filed by One Reporting Person | Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr.
 3) | 2. Transaction Date
 (Month/Day/Year) | 2A. Deemed Execution Date, if any
 (Month/Day/Year) | 3. Transaction Code (Instr.
 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr.
 3, 4 and 5) | 5.
 Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr.
 4) | 7. Nature of Indirect Beneficial Ownership (Instr.
 4)
Code | V | Amount | (A) or (D) | Price
Common Stock | 02/09/2021 | C | 23,231 | A | (1) | 23,231 | D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr.
 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date
 (Month/Day/Year) | 3A. Deemed Execution Date, if any
 (Month/Day/Year) | 4. Transaction Code (Instr.
 8) | 5.
 Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
 3, 4 and 5) | 6. Date Exercisable and Expiration Date
 (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr.
 3 and 4) | 8. Price of Derivative Security (Instr.
 5) | 9.
 Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr.
 4) | 11. Nature of Indirect Beneficial Ownership (Instr.
 4)
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares
Series C Preferred Stock | (1) | 02/09/2021 | C | 23,231 | (1) | (1) | Common Stock | 23,231 | $ 0.00 | 0 | D
Explanation of Responses:
1. Each share of Series C Preferred Stock (the "Preferred Stock") automatically converted on a one-for-one basis into Common Stock at the closing of the Issuer's initial public offering, for no additional consideration. The shares of Preferred Stock had no expiration date.
Remarks:
/s/ Dan George, Attorney-in-Fact for Kelly Lewis Brezoczky | 02/09/2021
** 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
 4

 (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.

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SEC_LHDX_4_filed2021-02-09_0001209191-21-009040.xml

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www.sec.gov