SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Boyd Jamie

(Last) (First) (Middle)
1000 2ND AVENUE, SUITE 1200

(Street)
SEATTLE WA 98104-1050

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Cascadia Acquisition Corp. [ CCAIU ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
CEO and CFO
3. Date of Earliest Transaction (Month/Day/Year)
08/26/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Common Stock (1) 08/26/2021 J(2) 75,000 (1) (1) Class A Common Stock 75,000 $0.006 4,237,500(3) I By Cascadia Acquisition Sponsor LLC(4)
Class B Common Stock (1) 08/30/2021 J(5) 937,500 (1) (1) Class A Common Stock 937,500 $0.006 3,300,000(3) I By Cascadia Acquisition Sponsor LLC(4)
Explanation of Responses:
1. As described in the issuer's registration statement on Form S-1 (File No. 333-258515) (the "Registration Statement") under the heading "Description of Securities-Founders Shares," the shares of Class B common stock, par value $0.0001 per share, of the issuer will automatically convert into shares of Class A common stock, par value $0.0001 per share, of the issuer upon the consummation of the issuer's initial business combination on a one-for-one basis, subject to certain adjustment, and have no expiration date.
2. In connection with the issuer's initial public offering and the appointment of Edgar Lee, Scott Prince and Arun Venkatadri to the issuer's board of directors, Cascadia Acquisition Sponsor LLC ("Sponsor") assigned 25,000 Class B shares to each of Edgar Lee, Scott Prince and Arun Venkatadri.
3. These shares represent Class B common stock held by the Sponsor and include up to 562,500 shares of Class B common stock that are subject to forfeiture depending on the extent to which the underwriters of the issuer's initial public offering exercise their over-allotment option as described in the Registration Statement.
4. As a manager of the Sponsor, the reporting person may be deemed to share beneficial ownership of the shares of Class B common stock held by the Sponsor. The reporting person disclaims any beneficial ownership of any shares held by the Sponsor except to the extent of his ultimate pecuniary interest.
5. In connection with the closing of the issuer's initial public offering, Cascadia Acquisition Sponsor LLC ("Sponsor") transferred an aggregate of 937,500 Class B shares to anchor investors pursuant to investment agreements by and among the issuer, the Sponsor and each anchor investor as described in the Registration Statement under the heading "Summary - The Offering - Expression of Interest."
/s/ Jamie Boyd 09/09/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.