0001209191-20-051512.txt : 20200922 0001209191-20-051512.hdr.sgml : 20200922 20200922171651 ACCESSION NUMBER: 0001209191-20-051512 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200922 FILED AS OF DATE: 20200922 DATE AS OF CHANGE: 20200922 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FLUKE JOHN M JR CENTRAL INDEX KEY: 0001191906 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39503 FILM NUMBER: 201190249 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Athira Pharma, Inc. CENTRAL INDEX KEY: 0001620463 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4000 MASON ROAD, SUITE 300 STREET 2: BOX 352141 CITY: SEATTLE STATE: WA ZIP: 981952141 BUSINESS PHONE: 5095927191 MAIL ADDRESS: STREET 1: 4000 MASON ROAD, SUITE 300 STREET 2: BOX 352141 CITY: SEATTLE STATE: WA ZIP: 981952141 FORMER COMPANY: FORMER CONFORMED NAME: M3 Biotechnology, Inc. DATE OF NAME CHANGE: 20140924 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2020-09-22 0 0001620463 Athira Pharma, Inc. ATHA 0001191906 FLUKE JOHN M JR C/O ATHIRA PHARMA, INC. 4000 MASON ROAD, SUITE 300 SEATTLE WA 98195 1 0 0 0 Common Stock 2020-09-22 4 C 0 12610 0.00 A 63050 D Common Stock 2020-09-22 4 C 0 51831 0.00 A 114881 D Common Stock 2020-09-22 4 C 0 6731 0.00 A 6731 I By Fluke Capital Management, L.P. Series A Preferred Stock 2020-09-22 4 C 0 12610 0.00 D Common Stock 12610 0 D Series A-1 Preferred Stock 2020-09-22 4 C 0 51831 0.00 D Common Stock 51831 0 D Series B-1 Preferred Stock 2020-09-22 4 C 0 6731 0.00 D Common Stock 6731 0 I By Fluke Capital Management, L.P. Each share of Series A Preferred Stock automatically converted into one share of Common Stock immediately prior to the completion of the Issuer's initial public offering of Common Stock and had no expiration date. Each share of Series A-1 Preferred Stock automatically converted into one share of Common Stock immediately prior to the completion of the Issuer's initial public offering of Common Stock and had no expiration date. Each share of Series B-1 Preferred Stock automatically converted into one share of Common Stock immediately prior to the completion of the Issuer's initial public offering of Common Stock and had no expiration date. /s/ Glenna Mileson, attorney-in-fact on behalf of John M. Fluke, Jr. 2020-09-22