0001140361-21-022188.txt : 20210624 0001140361-21-022188.hdr.sgml : 20210624 20210624164905 ACCESSION NUMBER: 0001140361-21-022188 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210618 FILED AS OF DATE: 20210624 DATE AS OF CHANGE: 20210624 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dyett John CENTRAL INDEX KEY: 0001610631 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40492 FILM NUMBER: 211043453 MAIL ADDRESS: STREET 1: 11111 SANTA MONICA BLVD., SUITE 2250 CITY: LOS ANGELES STATE: CA ZIP: 90025 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FEMASYS INC CENTRAL INDEX KEY: 0001339005 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3950 JOHNS CREEK COURT STREET 2: SUITE 100 CITY: SUWANEE STATE: GA ZIP: 30024 BUSINESS PHONE: 770-500-3910 MAIL ADDRESS: STREET 1: 3950 JOHNS CREEK COURT STREET 2: SUITE 100 CITY: SUWANEE STATE: GA ZIP: 30024 4 1 form4.xml FORM 4 X0306 4 2021-06-18 0001339005 FEMASYS INC FEMY 0001610631 Dyett John C/O FEMASYS INC. 3950 JOHNS CREEK COURT, SUITE 100 SUWANEE GA 30024 true true Common Stock 2021-06-18 4 P 0 2500 13.18 A 2500 I By IRA Common Stock 2021-06-22 4 C 0 948342 A 948342 I By Salem Femasys Investors LLC Common Stock 2021-06-22 4 C 0 2271453 A 3219795 I By Salem Femasys Investors LLC Common Stock 2021-06-18 4 P 0 10000 12.88 A 10000 I By the Dyett Family Trust Common Stock 2021-06-22 4 P 0 40000 13 A 50000 I By the Dyett Family Trust Common Stock 2021-06-22 4 C 0 63709 A 113709 I By the Dyett Family Trust Common Stock 2021-06-23 4 P 0 1000 9.95 A 114709 I By the Dyett Family Trust Series B Convertible Preferred Stock 2021-06-22 4 C 0 948342 D Common Stock 948342 0 I By Salem Femasys Investors LLC Series C Convertible Preferred Stock 2021-06-22 4 C 0 2271453 D Common Stock 2271453 0 I By Salem Femasys Investors LLC Series C Convertible Preferred Stock 2021-06-22 4 C 0 63709 D Common Stock 63709 0 I By the Dyett Family Trust 948,342 shares of Series B Convertible Preferred Stock were automatically converted into Common Stock in connection with the closing of the Issuer's initial public offering. The Series B Convertible Preferred Stock had no expiration date. Salem Femasys Investors LLC is a limited liability company consisting of 95 members, as of December 31, 2020. Mr. Dyett, acting as manager for Salem Femasys Investors LLC, has sole voting power over the shares held by Salem Femasys Investors LLC, subject to the vote of members holding more than 50% of the outstanding interests in Salem Femasys Investors LLC, and shares dispositive power over such shares, which powers may be exercised by members holding more than 50% of the outstanding interests in Salem Femasys Investors LLC, with each of the other members. Mr. Dyett disclaims beneficial ownership over the shares held by Salem Femasys Investors LLC, except to the extent of his pecuniary interest therein. 2,271,453 shares of Series C Convertible Preferred Stock were automatically converted into Common Stock in connection with the closing of the Issuer's initial public offering. The Series C Convertible Preferred Stock had no expiration date. 63,709 shares of Series C Convertible Preferred Stock were automatically converted into Common Stock in connection with the closing of the Issuer's initial public offering. The Series C Convertible Preferred Stock had no expiration date. /s/ Kathy Lee-Sepsick, Attorney-in-fact 2021-06-24