0001209191-21-007930.txt : 20210204 0001209191-21-007930.hdr.sgml : 20210204 20210204202628 ACCESSION NUMBER: 0001209191-21-007930 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20210204 FILED AS OF DATE: 20210204 DATE AS OF CHANGE: 20210204 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Susan Lior CENTRAL INDEX KEY: 0001832895 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39976 FILM NUMBER: 21592969 MAIL ADDRESS: STREET 1: 1412 62ND STREET CITY: EMERYVILLE STATE: CA ZIP: 94608 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 0001832895 Susan Lior 1412 62ND STREET EMERYVILLE CA 94608 1 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 I See footnote Convertible Promissory Note 13.60 2022-12-11 Common Stock 473729 I See footnote 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 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. /s/ Dan George, Attorney-in-Fact for Lior Susan 2021-02-04 EX-24.3_960289 2 poa.txt POA DOCUMENT POWER OF ATTORNEY Know all by these presents, that the undersigned hereby constitutes and appoints each of ERIK T. ENGELSON, DAN GEORGE and JOSH SEIDENFELD, signing individually, the undersigned's true and lawful attorneys-in-fact and agents to: (1) execute for and on behalf of the undersigned, in the undersigned's capacity as an officer, director or beneficial owner of more than 10% of a registered class of securities of LUCIRA 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 (the "Exchange Act") and the rules thereunder and a Form ID, Uniform Application for Access Codes to File on EDGAR; (2) do and perform any and all acts for and on behalf of the undersigned that may be necessary or desirable to execute such Forms 3, 4 or 5 or Form ID (including any amendments thereto) and timely file such forms with the United States Securities and Exchange Commission and any stock exchange or similar authority; and (3) take any other action of any nature whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit, 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 is the Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Exchange Act. This Power of Attorney shall remain in full force and effect until the earliest to occur of (a) 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, (b) revocation by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact or (c) as to any attorney-in-fact individually, until such attorney-in-fact is no longer employed by the Company or Cooley LLP. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of November 2, 2020. /s/ Lior Susan Lior Susan