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