0001140361-21-022197.txt : 20210624 0001140361-21-022197.hdr.sgml : 20210624 20210624165445 ACCESSION NUMBER: 0001140361-21-022197 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: Uzialko Edward R CENTRAL INDEX KEY: 0001856783 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40492 FILM NUMBER: 211043517 MAIL ADDRESS: STREET 1: 4605 DUDLEY LANE CITY: ATLANTA STATE: GA ZIP: 30327 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 0001856783 Uzialko Edward R C/O FEMASYS INC. 3950 JOHNS CREEK COURT, SUITE 100 SUWANEE GA 30024 true Common Stock 2021-06-22 4 P 0 100000 13 A 127786 D Common Stock 2021-06-22 4 C 0 1059445 A 1187231 D Common Stock 2021-06-22 4 C 0 30175 A 30175 I By Spouse Series A Convertible Preferred Stock 2021-06-22 4 C 0 1059445 D Common Stock 1059445 0 D Series B Convertible Preferred Stock 2021-06-22 4 C 0 30175 D Common Stock 30175 0 I By Spouse 1,059,445 shares of Series A Convertible Preferred Stock were automatically converted into Common Stock in connection with the closing of the Issuer's initial public offering. The Series A Convertible Preferred Stock had no expiration date. 30,175 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. /s/ Kathy Lee-Sepsick, Attorney-in-fact 2021-06-24