0001140361-21-033147.txt : 20210930 0001140361-21-033147.hdr.sgml : 20210930 20210930174303 ACCESSION NUMBER: 0001140361-21-033147 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210928 FILED AS OF DATE: 20210930 DATE AS OF CHANGE: 20210930 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Cui Xiangmin CENTRAL INDEX KEY: 0001487815 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40824 FILM NUMBER: 211296069 MAIL ADDRESS: STREET 1: NO. 14 EAST HUSHAN ROAD STREET 2: TAI'AN CITY CITY: SHANDONG STATE: F4 ZIP: 000000 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 2021-09-28 0001628945 Cue Health Inc. HLTH 0001487815 Cui Xiangmin C/O CUE HEALTH INC. 4980 CARROLL CANYON RD. SUITE 100 SAN DIEGO CA 92121 true Common Stock 2021-09-28 4 C 0 8192468 A 8192468 I See Footnote Common Stock 2021-09-28 4 A 0 788441 12.8 A 788441 I See Footnote Series C-1 Preferred Stock 2021-09-28 4 C 0 8192468 0 D Common Stock 8192468 0 I See Footnote On September 28, 2021, the Series C-1 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 shares are held directly by Decheng Capital China Life Sciences USD Fund III, L.P. (the "Fund"). Decheng Capital Management III (Cayman), LLC (the "GP") is the general partner of the Fund. The reporting person is the manager of the GP and disclaims beneficial ownership of such securities held by the Fund, except to the extent of his pecuniary interest therein, if any. On September 28, 2021, outstanding principal and accrued interest underlying a convertible note automatically converted into Common Stock upon the closing of the initial public offering of the Issuer's common stock at a conversion price equal to 80% of the initial public offering price per share. The shares are held directly by Decheng Capital Global Healthcare Fund (Master), LLC, whose general partner is Decheng Capital Global Healthcare GP, LLC. The reporting person is the sole member and manager of Decheng Capital Global Healthcare GP, LLC. The reporting person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein, if any. /s/ Erica Palsis, Attorney-in-Fact for Xiangmin Cui 2021-09-30