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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| C/O 23ANDME HOLDING CO. |
| 223 N. MATHILDA AVE |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
11/08/2021
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3. Issuer Name and Ticker or Trading Symbol
23andMe Holding Co.
[ ME ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
|
| No securities are beneficially owned. |
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/s/ Sandra R. Hernandez, by Kathy Hibbs, attorney-in-fact |
11/18/2021 |
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** 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. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
23ANDME HOLDING CO.
POWER OF ATTORNEY
Know all by these present, that I, the undersigned director and/or officer of
23andMe Holding Co., a Delaware corporation (the "Company"), hereby constitute
and appoint Kathy Hibbs, Jacqueline Haggarty, Guy Chayoun, and any assistant or
deputy counsel of the Company, and each of them, my true and lawful
attorneys-in-fact and agents, with full power to act, together or each without
the other, with full power of substitution and resubstitution, for me and in my
name, place, and stead, in any and all capacities:
(i) to execute and file for and on behalf of the undersigned any reports on
Forms 3, 4, and 5 (including any amendments thereto and any successors to such
Forms) with respect to ownership, acquisition, or disposition of securities of
the Company that the undersigned may be required to file with the U.S.
Securities and Exchange Commission (the "SEC") in accordance with Section 16(a)
of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), and the
rules promulgated thereunder;
(ii) to execute and file for and on behalf of the undersigned any voluntary
filings under Section 16(a) of the Exchange Act;
(iii) to request electronic filing codes from the SEC by filing the Form ID
(including amendments thereto) and any other documents necessary or appropriate
to obtain codes and passwords enabling the undersigned to file such reports
electronically;
(iv) to prepare, file, and submit any documents or reports that may be required
under SEC Rule 144 to permit the undersigned to sell Company common stock
without registration under the Securities Act of 1933, as amended (the
"Securities Act") in reliance on Rule 144 as amended from time to time; or
(v) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorneys-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorneys-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 attorneys-in-fact may approve in
such attorney-in-fact's or attorneys-in-fact's discretion.
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(a) of the Exchange Act or the Securities Act. The Company will
use all reasonable efforts to apprise the undersigned of applicable filing
requirements for purposes of Section 16(a) of the Exchange Act or the Securities
Act.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to the
undersigned's holdings and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact. This Power of Attorney revokes and replaces any
prior Power of Attorney executed by the undersigned with respect to the
ownership, acquisition, or disposition of securities of the Company.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 12th day of October, 2021.
/s/ Sandra Hernandez
Sandra Hernandez
