SEC FORM 3 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*
BLATT GREGORY R

(Last) (First) (Middle)
C/O VAXXINITY, INC
1717 MAIN ST, STE 3388

(Street)
DALLAS TX 75201

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/10/2021
3. Issuer Name and Ticker or Trading Symbol
Vaxxinity, Inc. [ VAXX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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)
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
Stock option (right to buy) (1) (1) Class A common stock 449,871 10.0673 D
Series A preferred stock (2) (2) Class A common stock (2) (2) I See Note(3)
Series A preferred stock (4) (4) Class A common stock (4) (4) I See Note(5)
Series B preferred stock (6) (6) Class A common stock (6) (6) I See Note(7)
Explanation of Responses:
1. Represents 449,871 time-vesting options. These options are subject to a two-year vesting schedule, beginning on 7/28/2021, vesting in equal installments each month during the vesting period.
2. The 968,636 shares of Series A preferred stock will convert into 622,516 shares of Class A common stock automatically upon closing of the initial public offering based on a conversion rate of approximately 0.643 shares of Class A common stock for each share of Series A preferred stock.
3. These shares are held by Blatt Family Investments LLC ("BFI"). The Reporting Person is the investment manager and a member of BFI, as well as the investment advisor of The Gregory R. Blatt 2018 GST Trust, which is also a member of BFI. The Reporting Person disclaims beneficial ownership, within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the securities held by BFI in which the Reporting Person has no pecuniary interest.
4. The 83,329 shares of Series A preferred stock will convert into 53,553 shares of Class A common automatically upon closing of the initial public offering based on a conversion rate of approximately 0.643 shares of Class A common stock for each share of Series A preferred stock.
5. These shares are held by The Gregory R. Blatt 2020 Annuity Trust IX. The Reporting Person is the sole trustee and the investment advisor with all investment authority.
6. The 250,000 shares of Series B preferred stock will convert into 160,668 shares of Class A common stock automatically upon closing of the initial public offering based on a conversion rate of approximately 0.643 shares of Class A common stock for each share of Series B preferred stock.
7. These shares are held by The Gregory R. Blatt 2020 Annuity Trust III. The Reporting Person is the sole trustee and the investment advisor with all investment authority.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Rene Paula, attorney-in-fact for Gregory R. Blatt 11/10/2021
** 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.
                                                               EXECUTION VERSION

                               POWER OF ATTORNEY

      Know all by these presents, that the undersigned hereby constitutes and
appoints Rene Paula as the undersigned's true and lawful attorney-in-fact to:

      (1) execute for and on behalf of the undersigned, in the undersigned's
      capacity as a reporting person pursuant to Section 16 of the Securities
      Exchange Act of 1934, as amended (the "Exchange Act"), and the rules
      thereunder of Vaxxinity, Inc. (the "Company"), Forms 3, 4 and 5, including
      any amendments thereto, in accordance with Section 16(a) of the Exchange
      Act;

      (2) do and perform any and all acts for and on behalf of the undersigned
      which may be necessary or desirable to complete and execute any such Form
      3, 4 or 5, complete and execute any amendment or amendments thereto and
      timely file such form with the United States Securities and Exchange
      Commission and the applicable stock exchange or similar authority; and

      (3) take any other action of any type whatsoever in connection with the
      foregoing which, in the opinion of such attorney-in-fact, may be of
      benefit to, in the best interest of, or legally required by, the
      undersigned, it being understood that the documents executed by such
      attorney-in-fact on behalf of the undersigned pursuant to this Power of
      Attorney shall be in such form and shall contain such terms and conditions
      as such attorney-in-fact may approve in the discretion of such attorney-
      in-fact.

      The undersigned hereby grants to such attorney-in-fact full power and
authority to act separately and to do and perform any and every act and thing
whatsoever requisite, necessary, or proper to be done in the exercise of any of
the rights and powers herein granted, as fully to all intents and purposes as
the undersigned might or could do if personally present, with full power of
substitution or revocation, hereby ratifying and confirming all that such
attorney-in-fact, or the substitute or substitutes of such attorney-in-fact,
shall lawfully do or cause to be done by virtue of this Power of Attorney and
the rights and powers herein granted. The undersigned acknowledges that the
foregoing attorney-in-fact, in serving in such capacity at the request of the
undersigned, is not assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with Section 16 of the Exchange Act.

      This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorney-in-fact.

      IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of this October 22, 2021.

                                        /s/ Greg Blatt
                                        ----------------------------------
                                        Name:
                                               Greg Blatt

                                        10/22/2021