Sec Form 4 Filing - Butler Michael Joseph @ Cascadia Acquisition Corp. - 2021-10-11

Insider filing report for Changes in Beneficial Ownership
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FORM 4
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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Butler Michael Joseph
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)
Chairman of the Board
(Last) (First) (Middle)
1000 2ND AVENUE, SUITE 1200
3. Date of Earliest Transaction (MM/DD/YY)
10/11/2021
(Street)
SEATTLE, WA98104-1050
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 ) 562,500 ( 1 ) ( 1 ) Class A Common Stock 562,500 ( 2 ) $ 0 2,737,500 I By Cascadia Acquisition Sponsor LLC ( 3 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Butler Michael Joseph
1000 2ND AVENUE, SUITE 1200
SEATTLE, WA98104-1050
X X Chairman of the Board
Signatures
/s/ Jamie Boyd, Attorney-in-Fact 10/13/2021
Signature of Reporting Person Date
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.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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