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^*

Yen Tuff

(Last)

(First)

(Middle)

1412 62ND STREET

(Street)

EMERYVILLE

94608

(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)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Series A Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock	416,069	⁽¹⁾	I	See footnote⁽²⁾
Series B Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock	737,489	⁽¹⁾	I	See footnote⁽²⁾
Series C Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock	951,885	⁽¹⁾	I	See footnote⁽³⁾
Convertible Promissory Note	⁽⁴⁾	12/11/2022	Common Stock	74,637	$13.6	I	See footnote⁽²⁾
Convertible Promissory Note	⁽⁴⁾	12/11/2022	Common Stock	61,588	$13.6	I	See footnote⁽³⁾
Stock Option (right to buy)	⁽⁵⁾	06/19/2029	Common Stock	51,334	$0.82	I	See footnote⁽⁶⁾

Explanation of Responses:

1. 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.

2. The securities are held directly by Seraph Diassess, LLC. Seraph Group LLC is the manager of Seraph Diassess, LLC and exercises investment and voting control over the shares held by Seraph Diassess, LLC. All investment decisions are made by Mr. Yen in his capacity as the President of Seraph Diassess, LLC. Mr. Yen disclaims beneficial ownership of the shares held by Seraph Diassess, LLC except to the extent of his pecuniary interest therein, if any.

3. The securities are held directly by Seraph Investments II, LLC. Seraph Group LLC is the manager of Seraph Investments II, LLC and exercises investment and voting control over the shares held by Seraph Investments II, LLC. All investment decisions are made by Mr. Yen in his capacity as the Manager of Seraph Investments II, LLC. Mr. Yen disclaims beneficial ownership of the shares held by Seraph Investments II, LLC except to the extent of his pecuniary interest therein, if any.

4. The convertible promissory note will automatically convert into shares of the Issuer's Common Stock upon the closing of the IPO.

5. The shares subject to the option are immediately exercisable. 1/24th of the shares subject to the option shall vest monthly over the two years from the vesting commencement date.

6. The securities are held directly by Seraph Group LLC. Mr. Yen is the president of Seraph Group LLC. All investment decisions are made by Mr. Yen in his capacity as the President of Seraph Group, LLC. Mr. Yen disclaims beneficial ownership of the shares held by Seraph Group, LLC except to the extent of his pecuniary interest therein, if any.

Remarks:

	/s/ Dan George, Attorney-in-Fact for Tuff Yen	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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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