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*
Tarsadia Capital, LLC

(Last) (First) (Middle)
10 EAST 53RD STREET
23RD FLOOR

(Street)
NEW YORK NY 10022

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/15/2023
3. Issuer Name and Ticker or Trading Symbol
Cue Health Inc. [ HLTH ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 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)
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)
Common stock, par value $0.00001 per share ("Common Stock")(1)(2) 10,684,791 I By: TCCS I, LP; TC GP, LLC and Tarsadia Capital, LLC. See footnotes(3)(6)
Common Stock(1)(2) 3,230,779 I By: NVGA I, LLC and Tarsadia Investments, LLC. See footnotes(4)(6)
Common Stock(1)(2) 3,612,913 I By: CP (HLTH), LLC and Tarsadia Investments, LLC. See footnotes(5)(6)
Common Stock(1)(2) 1,068,174 I By: TUP Investments, L.P. See footnote(6)
Common Stock(1)(2) 3,319,000 I By: T-Twelve Holdings, LLC and TFC Manager, LLC. See footnote(7)
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
1. Name and Address of Reporting Person*
Tarsadia Capital, LLC

(Last) (First) (Middle)
10 EAST 53RD STREET
23RD FLOOR

(Street)
NEW YORK NY 10022

(City) (State) (Zip)
1. Name and Address of Reporting Person*
TCCS I, LP

(Last) (First) (Middle)
10 EAST 53RD STREET
23RD FLOOR

(Street)
NEW YORK NY 10022

(City) (State) (Zip)
1. Name and Address of Reporting Person*
TC GP, LLC

(Last) (First) (Middle)
10 EAST 53RD STREET
23RD FLOOR

(Street)
NEW YORK NY 10022

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Tarsadia Investments, LLC

(Last) (First) (Middle)
520 NEWPORT CENTER DR.
21ST FLOOR

(Street)
NEWPORT BEACH CA 92660

(City) (State) (Zip)
1. Name and Address of Reporting Person*
NVGA I, LLC

(Last) (First) (Middle)
520 NEWPORT CENTER DR.
21ST FLOOR

(Street)
NEWPORT BEACH CA 92660

(City) (State) (Zip)
1. Name and Address of Reporting Person*
CP (HLTH), LLC

(Last) (First) (Middle)
520 NEWPORT CENTER DR.
21ST FLOOR

(Street)
NEWPORT BEACH CA 92660

(City) (State) (Zip)
1. Name and Address of Reporting Person*
TUP Investments, L.P.

(Last) (First) (Middle)
520 NEWPORT CENTER DR.
21ST FLOOR

(Street)
NEWPORT BEACH CA 92660

(City) (State) (Zip)
1. Name and Address of Reporting Person*
T-Twelve Holdings, LLC

(Last) (First) (Middle)
C/O SIERRA FIDUCIARY SUPPORT SERVICES
100 WEST LIBERTY ST., SUITE 750

(Street)
RENO NV 89501

(City) (State) (Zip)
1. Name and Address of Reporting Person*
TFC Manager, LLC

(Last) (First) (Middle)
C/O SIERRA FIDUCIARY SUPPORT SERVICES
100 WEST LIBERTY ST., SUITE 750

(Street)
RENO NV 89501

(City) (State) (Zip)
Explanation of Responses:
1. This Form 3 is filed jointly by TCCS I, LP ("TCCS"), TC GP, LLC ("TC GP"), Tarsadia Capital, LLC ("Tarsadia Capital"), Tarsadia Investments, LLC ("Tarsadia Investments"), NVGA I, LLC ("NVGA"), CP (HLTH), LLC ("CP HLTH"), TUP Investments, L.P. ("TUP Investments"), T-Twelve Holdings, LLC ("T-Twelve Holdings"), and TFC Manager, LLC ("TFC Manager"). Each of the foregoing is referred to as a "Reporting Person" and collectively as the "Reporting Persons."
2. Each of the Reporting Persons disclaims beneficial ownership of the securities reported herein except to the extent of its pecuniary interest therein, if any, and the filing of this Form 3 shall not be construed as an admission that any Reporting Person is the beneficial owner of any such securities for purposes of Section 16(a) of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), or for any other purpose. Each of the Reporting Persons may be deemed to be a member of a "group" for purposes of Section 13(d) of the Exchange Act that may be deemed to collectively beneficially own over 10% of the Issuer's outstanding securities.
3. Securities held by TCCS. TC GP is the general partner of TCCS. Tarsadia Capital is the investment manager to TCCS.
4. Securities held by NVGA. Tarsadia Investments is the investment manager to NVGA.
5. Securities held by CP HLTH. Tarsadia Investments is the investment manager to CP HLTH.
6. Tushar Patel, a United States citizen is the ultimate control person of each of TCCS, TC GP, Tarsadia Capital, NVGA, CP HLTH, Tarsadia Investments, and TUP Investments.
7. Securities held by T-Twelve Holdings. TFC Manager is the manager of T-Twelve Holdings. Gautam Patel, a United States citizen, is the ultimate control person of each of TFC Manager and T-Twelve Holdings.
TCCS I, LP, By: TC GP, LLC, its General Partner /s/ Vikram Patel, Authorized Signatory 09/22/2023
TC GP, LLC, By: /s/ Vikram Patel, Authorized Signatory 09/22/2023
TARSADIA CAPITAL, LLC, By: /s/ Vikram Patel, Head of Tarsadia Capital, LLC 09/22/2023
NVGA I, LLC, By: TI Manager, LLC, its Manager /s/ Vikram Patel, Managing Director 09/22/2023
CP (HLTH), LLC, By: TI Manager, LLC, its Manager /s/ Vikram Patel, Managing Director 09/22/2023
TARSADIA INVESTMENTS, LLC, By: /s/ Mitchell Caplan, President 09/22/2023
TUP INVESTMENTS, L.P., By: TUP Three, LLC, its General Partner /s/ Vikram Patel, Manager 09/22/2023
T-TWELVE HOLDINGS, LLC, By: TFC Manager, LLC, its Manager /s/ Gautam Patel, Manager 09/22/2023
TFC MANAGER, LLC, By: /s/ Gautam Patel, Manager 09/22/2023
** 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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