0001209191-21-007928.txt : 20210204 0001209191-21-007928.hdr.sgml : 20210204 20210204202520 ACCESSION NUMBER: 0001209191-21-007928 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210204 FILED AS OF DATE: 20210204 DATE AS OF CHANGE: 20210204 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Eclipse GP III, LLC CENTRAL INDEX KEY: 0001763854 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39976 FILM NUMBER: 21592963 BUSINESS ADDRESS: STREET 1: 514 HIGH STREET, SUITE 4 CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: (415) 692-1720 MAIL ADDRESS: STREET 1: 514 HIGH STREET, SUITE 4 CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Eclipse Ventures Fund I, L.P. CENTRAL INDEX KEY: 0001641394 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39976 FILM NUMBER: 21592964 BUSINESS ADDRESS: STREET 1: 501 SECOND STREET SUITE 300 CITY: SAN FRANCISCO STATE: CA ZIP: 94107 BUSINESS PHONE: (415) 366-8393 MAIL ADDRESS: STREET 1: 501 SECOND STREET SUITE 300 CITY: SAN FRANCISCO STATE: CA ZIP: 94107 FORMER NAME: FORMER CONFORMED NAME: Formation8 Partners Hardware Fund I, L.P. DATE OF NAME CHANGE: 20150505 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Eclipse Fund III, L.P. CENTRAL INDEX KEY: 0001763853 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39976 FILM NUMBER: 21592965 BUSINESS ADDRESS: STREET 1: 514 HIGH STREET, SUITE 4 CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: (415) 692-1720 MAIL ADDRESS: STREET 1: 514 HIGH STREET, SUITE 4 CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Eclipse Ventures GP I, LLC CENTRAL INDEX KEY: 0001843678 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39976 FILM NUMBER: 21592966 BUSINESS ADDRESS: STREET 1: 514 HIGH STREET STREET 2: SUITE 4 CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: 650-720-4667 MAIL ADDRESS: STREET 1: 514 HIGH STREET STREET 2: SUITE 4 CITY: PALO ALTO STATE: CA ZIP: 94301 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Lucira Health, Inc. CENTRAL INDEX KEY: 0001652724 STANDARD INDUSTRIAL CLASSIFICATION: IN VITRO & IN VIVO DIAGNOSTIC SUBSTANCES [2835] IRS NUMBER: 272491037 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1412 62ND STREET CITY: EMERYVILLE STATE: CA ZIP: 94608 BUSINESS PHONE: (814) 574-1546 MAIL ADDRESS: STREET 1: 1412 62ND STREET CITY: EMERYVILLE STATE: CA ZIP: 94608 FORMER COMPANY: FORMER CONFORMED NAME: DiAssess Inc. DATE OF NAME CHANGE: 20150908 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2021-02-04 0 0001652724 Lucira Health, Inc. LHDX 0001763854 Eclipse GP III, LLC 514 HIGH STREET SUITE 4 PALO ALTO CA 94301 0 0 1 0 0001641394 Eclipse Ventures Fund I, L.P. 514 HIGH STREET SUITE 4 PALO ALTO CA 94301 0 0 1 0 0001763853 Eclipse Fund III, L.P. 514 HIGH STREET SUITE 4 PALO ALTO CA 94301 0 0 1 0 0001843678 Eclipse Ventures GP I, LLC 514 HIGH STREET SUITE 4 PALO ALTO CA 94301 0 0 1 0 Series A Preferred Stock Common Stock 976852 I See footnote Series B Preferred Stock Common Stock 877445 I See footnote Series C Preferred Stock Common Stock 185512 I See footnote Series C Preferred Stock Common Stock 3710257 D Convertible Promissory Note 13.60 2022-12-11 Common Stock 473729 D Each share of Series A Preferred Stock, Series B Preferred Stock, and 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 (the "IPO"), for no additional consideration. The shares of Preferred Stock have no expiration date. The securities are held directly by Eclipse Ventures Fund I, L.P. ("Eclipse I"). Eclipse Ventures GP I, LLC ("Eclipse I GP") is the general partner of Eclipse I and may be deemed to have voting and dispositive power over the shares held by Eclipse I. Mr. Susan, a member of the Issuer's board of directors, is the sole managing member of Eclipse I GP and may be deemed to have voting and dispositive power over the shares held by Eclipse I. Eclipse I GP and Mr. Susan disclaim beneficial ownership of the shares held by Eclipse I except to the extent of their respective pecuniary interests therein, if any. The securities are held directly by Eclipse Fund III, L.P. ("Eclipse III"). Eclipse GP III, LLC ("Eclipse III GP") is the general partner of Eclipse III and may be deemed to have voting and dispositive power over the shares held by Eclipse III. Mr. Susan, a member of the Issuer's board of directors, is the sole managing member of Eclipse III GP and may be deemed to have voting and dispositive power over the shares held by Eclipse III. Eclipse III GP and Mr. Susan disclaim beneficial ownership of the shares held by Eclipse III except to the extent of their respective pecuniary interests therein, if any. The convertible promissory note will automatically convert into shares of the Issuer's Common Stock upon the closing of the IPO. Eclipse GP III, LLC /s/ Lior Susan, Managing Member 2021-02-04 Eclipse Ventures Fund I, L.P. By: Eclipse Ventures GP I, LLC, its General Partner /s/ Lior Susan, Managing Member 2021-02-04 Eclipse Fund III, L.P., By: Eclipse GP III, LC, its General Partner, /s/ Lior Susan, Managing Member 2021-02-04 Eclipse Ventures GP I, LLC /s/ Lior Susan, Managing Member 2021-02-04