0001104659-22-097017.txt : 20220901 0001104659-22-097017.hdr.sgml : 20220901 20220901160642 ACCESSION NUMBER: 0001104659-22-097017 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220830 FILED AS OF DATE: 20220901 DATE AS OF CHANGE: 20220901 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Derby Michael CENTRAL INDEX KEY: 0001809613 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41475 FILM NUMBER: 221221029 MAIL ADDRESS: STREET 1: 303 SOUTH BROADWAY STREET 2: SUITE 125 CITY: TARRYTOWN STATE: NY ZIP: 10591 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PaxMedica, Inc. CENTRAL INDEX KEY: 0001811623 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 50 TICE BOULEVARD, SUITE A26 CITY: WOODCLIFF LAKE STATE: NJ ZIP: 07677 BUSINESS PHONE: 650-889-5020 MAIL ADDRESS: STREET 1: 50 TICE BOULEVARD, SUITE A26 CITY: WOODCLIFF LAKE STATE: NJ ZIP: 07677 4 1 tm2224962-1_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2022-08-30 0 0001811623 PaxMedica, Inc. PXMD 0001809613 Derby Michael C/O PAXMEDICA, INC. 303 SOUTH BROADWAY, SUITE 125 TARRYTOWN NY 10591 1 1 1 0 Executive Chairman Common Stock 361000 D Common Stock 2022-08-30 4 P 0 95000 5.25 A 7336745 I TardiMed Sciences, LLC Includes restricted stock units that vest as described in the Company's Registration Statement on Form S-1 (File No. 333-239676). These shares were purchased from the underwriters by TardiMed Sciences, LLC ("TardiMed") in the issuer's initial public offering, which closed on August 30, 2022. See footnote 3 for the reporting person's relationship to TardiMed. The reporting person is the Managing Partner of TardiMed and has sole voting and dispositive control over the shares of Common Stock held by the entity. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. /s/ Michael Derby 2022-08-31