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