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
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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).
1. Name and Address of Reporting Person*
Cascadia Acquisition Sponsor LLC

(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)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
10/11/2021
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) 10/11/2021 D(2) 562,500 (1) (1) Class A Common Stock 562,500(2) $0.0000 2,737,500 D(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. The Sponsor is managed by its managers, Michael Butler, Chairman of the Board of the issuer, and Jamie Boyd, Chief Executive Officer of the issuer. Each of Mr. Butler and Mr. Boyd has voting and investment discretion with respect to the common stock held by the Sponsor. As such, each of Mr. Butler and Mr. Boyd may be deemed to share beneficial ownership of the shares of Class B common stock held by the Sponsor. Each of Mr. Butler and Mr. Boyd disclaims any beneficial ownership of any shares held by the Sponsor except to the extent of his ultimate pecuniary interest.
/s/ Jamie Boyd, Chief Executive Officer 10/13/2021
** 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).
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