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*
Bassaganya-Riera Josep

(Last) (First) (Middle)
C/O LANDOS BIOPHARMA, INC.
1800 KRAFT DRIVE, SUITE 216

(Street)
BLACKSBURG VA 24060

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/03/2021
3. Issuer Name and Ticker or Trading Symbol
Landos Biopharma, Inc. [ LABP ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
Chairman, President and 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 8,229,881(1)(2) I By Trust(3)
Common Stock 766,405(2) I By GRAT(4)
Common Stock 823,956(2) I By GRAT(5)
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
Explanation of Responses:
1. Of these shares, 285,140 shares are unvested and subject to repurchase by the Issuer if the Reporting Person ceases to provide services to the Issuer prior to the vesting of the shares.
2. Reflects a 1.8249-for-1 stock split of the Issuer's common stock effected on January 29, 2021.
3. Securities are held by the the Josep Bassaganya-Riera Revocable Trust Agreement dated April 9, 2018, as amended (the "2018 Trust"). The Reporting Person is the sole trustee of the 2018 Trust and the beneficiaries are the Reporting Person's immediate family members. The Reporting Person disclaims beneficial ownership of these securities, except to the extend of his pecuniary interest therein.
4. These Shares are held by the the Josep Bassaganya-Riera Grantor Retained Annuity Trust No. 1 dated June 28, 2018 (the "2018 GRAT"). The Reporting Person is the sole trustee of the 2018 GRAT and the beneficiaries are the Reporting Person's immediate family members. The Reporting Person disclaims beneficial ownership of these securities, except to the extend of his pecuniary interest therein.
5. These Shares are held by the the Josep Bassaganya-Riera Grantor Retained Annuity Trust No. 2 dated March 26, 2019 (the "2019 GRAT"). The Reporting Person is the sole trustee or the 2019 GRAT and the beneficiaries are the Reporting Person's immediate family members. The Reporting Person disclaims beneficial ownership of these securities, except to the extend of his pecuniary interest therein.
Remarks:
Exhibit List - Exhibit 24 - Power of Attorney
/s/ Eric W. Blanchard, Attorney-in-Fact 02/03/2021
** 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 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.