0001140361-21-032365.txt : 20210923 0001140361-21-032365.hdr.sgml : 20210923 20210923210703 ACCESSION NUMBER: 0001140361-21-032365 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20210923 FILED AS OF DATE: 20210923 DATE AS OF CHANGE: 20210923 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Achar Christopher K CENTRAL INDEX KEY: 0001868312 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40824 FILM NUMBER: 211273823 MAIL ADDRESS: STREET 1: C/O CUE HEALTH INC. STREET 2: 4980 CARROLL CANYON RD. SUITE 100 CITY: SAN DIEGO STATE: CA ZIP: 92121 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Cue Health Inc. CENTRAL INDEX KEY: 0001628945 STANDARD INDUSTRIAL CLASSIFICATION: LABORATORY ANALYTICAL INSTRUMENTS [3826] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4980 CARROLL CANYON ROAD STREET 2: SUITE 100 CITY: SAN DIEGO STATE: CA ZIP: 92121 BUSINESS PHONE: (858) 412-8151 MAIL ADDRESS: STREET 1: 4980 CARROLL CANYON ROAD STREET 2: SUITE 100 CITY: SAN DIEGO STATE: CA ZIP: 92121 FORMER COMPANY: FORMER CONFORMED NAME: Cue Inc. DATE OF NAME CHANGE: 20141223 FORMER COMPANY: FORMER CONFORMED NAME: Cue, Inc. DATE OF NAME CHANGE: 20141222 3 1 form3.xml FORM 3 X0206 3 2021-09-23 0 0001628945 Cue Health Inc. HLTH 0001868312 Achar Christopher K C/O CUE HEALTH INC. 4980 CARROLL CANYON RD. SUITE 100 SAN DIEGO CA 92121 true true Chief Strategy Officer Common Stock 1520000 I See Footnote Series B Preferred Stock Common Stock 69710 D The securities are directly held by Hlth Wrk LLC. Chris Achar is the sole manager of Hlth Wrk LLC and may be deemed to have voting and investment power with respect to the shares held by Hlth Wrk LLC and as a result may be deemed to have beneficial ownership of such shares. The Series B Preferred Stock automatically converts into the number of shares of Common Stock as shown in Column 3 of Table II without payment of further consideration at the holder's election or upon closing of the initial public offering of the Issuer's common stock. The shares have no expiration date. Exhibit Index: 24.1 Power of Attorney /s/ Erica Palsis, Attorney-in-Fact for Chris Achar 2021-09-23 EX-24.1 2 brhc10029216_ex24-1.htm EXHIBIT 24.1
Exhibit 24.1

LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING OBLIGATIONS

Know all by these presents, that the undersigned hereby makes, constitutes and appoints each of Erica Palsis and John Edward Gallagher, signing singly and each acting individually, as the undersigned's true and lawful attorney‑in‑fact with full power and authority as hereinafter described to:
 
(1)          execute for and on behalf of the undersigned, in the undersigned's capacity as an officer, director and/or stockholder of Cue Health Inc. (the “Company”), Forms 3, 4, and 5 (including any amendments thereto) in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended, and the rules thereunder (the “Exchange Act”);
 
(2)          do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to prepare, complete and execute any such Form 3, 4, or 5, prepare, complete and execute any amendment or amendments thereto, and timely deliver and file such form with the United States Securities and Exchange Commission (the “SEC”) and any stock exchange or similar authority, including, without limitation, the filing of a Form ID, Update Passphrase, or any other application materials to enable the undersigned to gain or maintain access to the Electronic Data Gathering, Analysis and Retrieval system of the SEC;
 
(3)          seek or obtain, as the undersigned’s representative and on the undersigned’s behalf, information regarding transactions in the Company’s securities from any third party, including brokers, employee benefit plan administrators and trustees, and the undersigned hereby authorizes any such person to release any such information to such attorney‑in‑fact and approves and ratifies any such release of information; and
 
(4)          take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney‑in‑fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney‑in‑fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney‑in‑fact may approve in such attorney‑in‑fact's discretion.
 
The undersigned hereby grants to each such attorney‑in‑fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney‑in‑fact, or such attorney‑in‑fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted.  The undersigned acknowledges that the foregoing attorneys‑in‑fact, in serving in such capacity at the request of the undersigned, are not assuming nor relieving, nor is the Company assuming nor relieving, any of the undersigned's responsibilities to comply with Section 16 of the Exchange Act.  The undersigned acknowledges that neither the Company nor the foregoing attorneys‑in‑fact assume (i) any liability for the undersigned’s responsibility to comply with the requirement of the Exchange Act, (ii) any liability of the undersigned for any failure to comply with such requirements, or (iii) any obligation or liability of the undersigned for profit disgorgement under Section 16(b) of the Exchange Act.
 
This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys‑in‑fact.
 
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 3rd day of June, 2021.
 
 
/s/  Chris Achar
 
Signature
   
 
Chris Achar
 
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