SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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1. Name and Address of Reporting Person*
EPIQ Capital Group, LLC

(Last) (First) (Middle)
ONE LOMBARD STREET, SUITE 200

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/04/2021
3. Issuer Name and Ticker or Trading Symbol
Lucira Health, Inc. [ LHDX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
Officer (give title below) X Other (specify below)
Managing Mbr of 10% Owners
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Series B Convertible Preferred (1) (1) Common Stock 32,176 (1) D(3)(7)
Series B Convertible Preferred (1) (1) Common Stock 3,754,084 (1) D(4)(7)
Series C Convertible Preferred (1) (1) Common Stock 5,173,026 (1) D(5)(7)
2020B Convertible Promissory Note (2) 12/11/2022 Common Stock 735,475 17 D(6)(7)
1. Name and Address of Reporting Person*
EPIQ Capital Group, LLC

(Last) (First) (Middle)
ONE LOMBARD STREET, SUITE 200

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
1. Name and Address of Reporting Person*
EPQ LLC, LFLU PS

(Last) (First) (Middle)
9650 GATEWAY DRIVE, SUITE 200

(Street)
RENO NV 89521

(City) (State) (Zip)
1. Name and Address of Reporting Person*
EPQ LLC, LCOVD PS

(Last) (First) (Middle)
9650 GATEWAY DRIVE, SUITE 200

(Street)
RENO NV 89521

(City) (State) (Zip)
1. Name and Address of Reporting Person*
EPQ LLC, LCOVD SAFE PS

(Last) (First) (Middle)
9650 GATEWAY DRIVE, SUITE 200

(Street)
RENO NV 89521

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Boeding Chad

(Last) (First) (Middle)
ONE LOMBARD STREET, SUITE 200

(Street)
SAN FRANCISCO CA 94111

(City) (State) (Zip)
Explanation of Responses:
1. Each share of 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.
2. The convertible promissory note will automatically convert into shares of the Issuer's Common Stock upon the closing of the IPO.
3. Chad Boeding is the beneficial owner of these shares through a trust that he controls.
4. EPQ LLC, LFLU PS ("LFLU") is the direct beneficial owner of these shares.
5. EPQ LLC, LCOVD PS ("LCOVD") is the direct beneficial owner of these shares.
6. EPQ LLC, LCOVD SAFE PS ("SAFE") is the direct beneficial owner of this note.
7. The reporting persons are EPIQ Capital Group, LLC ("EPIQ"), Chad Boeding, LFLU, LCOVD, and SAFE. EPIQ is the Managing Member of LFLU, LCOVD, and SAFE. Mr. Boeding is the CEO and Manager of EPIQ. EPIQ is filing this Form 3 on behalf of the reporting persons jointly, but not as a group. EPIQ, LFLU, LCOVD, SAFE, and Mr. Boeding each disclaims beneficial ownership of the securities reported herein for purposes of Section 16 of the Securities Exchange Act of 1934 except to the extent of its or his pecuniary interest therein, if any. This report shall not be deemed an admission that any of the Reporting Persons is a beneficial owner of such securities for the purpose of Section 16 of the Exchange Act, or for any other purpose.
EPQ LLC, LFLU PS, by EPIQ Capital Group, LLC, its Managing Member, by Chad Boeding, its CEO and Manager, /s/ Chad Boeding 02/04/2021
EPQ LLC, LCOVD PS, by EPIQ Capital Group, LLC, its Managing Member, by Chad Boeding, its CEO and Manager, /s/ Chad Boeding 02/04/2021
EPQ LLC, LCOVD SAFE PS, by EPIQ Capital Group, LLC, its Managing Member, by Chad Boeding, its CEO and Manager, /s/ Chad Boeding 02/04/2021
EPIQ Capital Group, LLC, by Chad Boeding, its CEO and Manager, /s/ Chad Boeding 02/04/2021
/s/ Chad Boeding 02/04/2021
** 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 5 (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).
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