0001140361-21-032809.txt : 20210928 0001140361-21-032809.hdr.sgml : 20210928 20210928171738 ACCESSION NUMBER: 0001140361-21-032809 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210924 FILED AS OF DATE: 20210928 DATE AS OF CHANGE: 20210928 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Achar Christopher K CENTRAL INDEX KEY: 0001868312 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40824 FILM NUMBER: 211288278 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 4 1 form4.xml FORM 4 X0306 4 2021-09-24 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 Common Stock 2021-09-24 4 A 0 1388246 0 A 1388246 D Common Stock 2021-09-28 4 C 0 69710 A 1457956 D Common Stock 1520000 I See Footnote Series B Preferred Stock 2021-09-28 4 C 0 69710 D Common Stock 69710 0 D Grant of restricted stock units ("RSUs") under the Issuer's 2021 Stock Incentive Plan. Each RSU represents a contingent right to receive one share of the Issuer's common stock. Subject to the reporting person's continued service with the Issuer, the RSUs will vest as to 25% of the initial grant on each anniversary of the grant date until the grant is fully vested on the fourth anniversary of the grant date. Includes 1,388,246 unvested RSUs. On September 28, 2021, the Series B Preferred Stock automatically converted into Common Stock on a one-to-one basis without payment of further consideration upon the closing of the initial public offering of the Issuer's common stock. The shares had no expiration date. 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. /s/ Erica Palsis, Attorney-in-Fact for Chris Achar 2021-09-28