SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
KAWAS LEEN

(Last) (First) (Middle)
C/O ATHIRA PHARMA, INC.
4000 MASON ROAD, SUITE 300

(Street)
SEATTLE WA 98195

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/17/2020
3. Issuer Name and Ticker or Trading Symbol
Athira Pharma, Inc. [ ATHA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
President & CEO
5. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock(1) 1,117,246 D
Common Stock(1) 264,810 I By Hamdan Family GST Trust
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy)(1) (2) 08/28/2024 Common Stock 25,220 $0.16 D
Stock Option (Right to Buy)(1) (3) 08/28/2024 Common Stock 50,440 $0.16 D
Stock Option (Right to Buy)(1) (4) 10/23/2025 Common Stock 151,320 $0.48 D
Stock Option (Right to Buy)(1) (5) 01/21/2023 Common Stock 63,050 $1.31 D
Stock Option (Right to Buy)(1) (6) 12/17/2023 Common Stock 31,525 $1.49 D
Stock Option (Right to Buy)(1) (7) 09/16/2030 Common Stock 209,956 $17 D
Explanation of Responses:
1. Reflects a 7.9302-for-1 reverse stock split of the outstanding shares of the Issuer effected September 11, 2020.
2. The shares subject to the option fully vested on January 20, 2016.
3. The shares subject to the option fully vested on August 29, 2014.
4. The shares subject to the option fully vested on October 24, 2017.
5. The shares subject to the option fully vested on December 1, 2019.
6. One-third of the shares subject to the option vested on January 1, 2020 and one-third of the shares subject to the option vest on each year thereafter.
7. One-fourth of the shares subject to the option will vest on August 26, 2021 and one-fourth of the shares subject to the option vest on each year thereafter.
Remarks:
Glenna Mileson, Attorney in fact for Leen Kawas 09/17/2020
** 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 5 (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.
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