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