0001140361-21-022194.txt : 20210624 0001140361-21-022194.hdr.sgml : 20210624 20210624165307 ACCESSION NUMBER: 0001140361-21-022194 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210622 FILED AS OF DATE: 20210624 DATE AS OF CHANGE: 20210624 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Larsen Charles CENTRAL INDEX KEY: 0001857458 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40492 FILM NUMBER: 211043501 MAIL ADDRESS: STREET 1: 28 SANDPIPER ROAD CITY: TAMPA STATE: FL ZIP: 33609 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 2021-06-22 0001339005 FEMASYS INC FEMY 0001857458 Larsen Charles C/O FEMASYS INC. 3950 JOHNS CREEK COURT, SUITE 100 SUWANEE GA 30024 true Common Stock 2021-06-22 4 P 0 7000 13 A 7000 D Common Stock 2021-06-22 4 C 0 10587 A 17587 D Series C Convertible Preferred Stock 2021-06-22 4 C 0 10587 D Common Stock 10587 0 D 10,587 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