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