Form 4: Lucira Health, Inc. (LHDX), Yen Tuff, transaction 02/09/2021

Summary

Tuff Yen, a Director of Lucira Health, Inc. [ LHDX ], reports conversions into Common Stock on 02/09/2021 at the closing of the issuer's initial public offering. Seraph Diassess, LLC converted 416,069 Series A and 737,489 Series B Preferred shares, plus a Convertible Promissory Note of $ 1,015,065.29 at $ 13.6 into 74,637 shares, ending at 1,228,195 shares. Seraph Investments II, LLC converted 951,885 Series C Preferred shares and a $ 837,603.6 note into 61,588 shares, ending at 1,013,473. Footnotes say Seraph Group LLC manages both and Mr. Yen makes the investment decisions; he disclaims beneficial ownership beyond his pecuniary interest. Signed by /s/ Dan George, Attorney-in-Fact, 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 * Yen Tuff (Last) (First) (Middle) 1412 62ND STREET (Street) EMERYVILLE CA 94608 (City) (State) (Zip) | Yen Tuff | (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) X Director 10% Owner Officer (give title below) Other (specify below) | X | Director | 10% Owner | Officer (give title below) | Other (specify below)
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 | 416,069 | A | (1) | 416,069 | I | See footnote (2)
Common Stock | 02/09/2021 | C | 737,489 | A | (1) | 1,153,558 | I | See footnote (2)
Common Stock | 02/09/2021 | C | 74,637 | A | $ 13.6 | 1,228,195 | I | See footnote (2)
Common Stock | 02/09/2021 | C | 951,885 | A | (1) | 951,885 | I | See footnote (3)
Common Stock | 02/09/2021 | C | 61,588 | A | $ 13.6 | 1,013,473 | I | See footnote (3)
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 A Preferred Stock | (1) | 02/09/2021 | C | 416,069 | (1) | (1) | Common Stock | 416,069 | $ 0.00 | 0 | I | See footnote (2)
Series B Preferred Stock | (1) | 02/09/2021 | C | 737,489 | (1) | (1) | Common Stock | 737,489 | $ 0.00 | 0 | I | See footnote (2)
Convertible Promissory Note | $ 13.6 | 02/09/2021 | C | $ 1,015,065.29 | (4) | 12/11/2022 | Common Stock | 74,637 | $ 0.00 | 0 | I | See footnote (2)
Series C Preferred Stock | (1) | 02/09/2021 | C | 951,885 | (1) | (1) | Common Stock | 951,885 | $ 0.00 | 0 | I | See footnote (3)
Convertible Promissory Note | $ 13.6 | 02/09/2021 | C | $ 837,603.6 | (4) | 12/11/2022 | Common Stock | 61,588 | $ 0.00 | 0 | I | See footnote (3)
Explanation of Responses:
1. Each share of Series A Preferred, Series B Preferred Stock and 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.
2. The securities are held directly by Seraph Diassess, LLC. Seraph Group LLC is the manager of Seraph Diassess, LLC and exercises investment
and voting control over the shares held by Seraph Diassess, LLC. All investment decisions are made by Mr. Yen in his capacity as the President
of Seraph Diassess, LLC. Mr. Yen disclaims beneficial ownership of the shares held by Seraph Diassess, LLC except to the extent of his
pecuniary interest therein, if any.
3. The securities are held directly by Seraph Investments II, LLC. Seraph Group LLC is the manager of Seraph Investments II, LLC and exercises
investment and voting control over the shares held by Seraph Investments II, LLC. All investment decisions are made by Mr. Yen in his capacity
as the Manager of Seraph Investments II, LLC. Mr. Yen disclaims beneficial ownership of the shares held by Seraph Investments II, LLC except
to the extent of his pecuniary interest therein, if any.
4. The convertible promissory note automatically converted into shares of the Issuer's Common Stock at the closing of the IPO.
Remarks:
/s/ Dan George, Attorney-in-Fact for Tuff Yen | 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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