Statement of Changes in Beneficial Ownership (4)
14 October 2021 - 9:04AM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
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Boyd Jamie |
2. Issuer Name and Ticker or Trading Symbol
Cascadia Acquisition Corp.
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CCAIU
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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 |
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(Last)
(First)
(Middle)
1000 2ND AVENUE, SUITE 1200 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
10/11/2021 |
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(Street)
SEATTLE, WA 98104-1050
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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) | 10/11/2021 | | D (2) | | | 562500.0000 | (1) | (1) | Class A Common Stock | 562500.0000 (2) | $0.0000 | 2737500.0000 | I | By Cascadia Acquisition Sponsor LLC (3) |
| 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) | Cascadia Acquisition Sponsor LLC (the "Sponsor") forfeited 562,500 shares of Class B common stock to the issuer for no consideration, which was exempted pursuant to Rule 16b-3(e) under the Securities Exchange Act of 1934, as amended, in connection with the underwriters' election not to exercise their over-allotment option. |
| (3) | 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. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Boyd Jamie
1000 2ND AVENUE, SUITE 1200
SEATTLE, WA 98104-1050 | X | X | CEO and CFO |
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Signatures
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| /s/ Jamie Boyd | | 10/13/2021 |
| **Signature of Reporting Person | Date |
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