0001140361-21-042254.txt : 20211217
0001140361-21-042254.hdr.sgml : 20211217
20211217170838
ACCESSION NUMBER: 0001140361-21-042254
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211215
FILED AS OF DATE: 20211217
DATE AS OF CHANGE: 20211217
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Witte William Benson
CENTRAL INDEX KEY: 0001857671
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40492
FILM NUMBER: 211502486
MAIL ADDRESS:
STREET 1: 11111 SANTA MONICA BLVD.
STREET 2: 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
2021-12-15
0001339005
FEMASYS INC
FEMY
0001857671
Witte William Benson
C/O FEMASYS INC.
3950 JOHNS CREEK COURT, SUITE 100
SUWANEE
GA
30024
true
Common Stock
2021-12-15
4
J
0
12191
0
A
12191
D
Pro rata distribution from Salem Femasys Investors LLC, of which the reporting person is a non-managing member.
/s/ Kathy Lee-Sepsick, Attorney-in-fact
2021-12-17