SEC FORM 4 SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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. Issuer Name and Ticker or Trading Symbol
Vaxxinity, Inc. [ VAXX ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
11/16/2021
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 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
Class A common stock 622,516 I Held by Blatt Family Investments LLC(1)
Class A common stock 53,553 I Held by The Gregory R. Blatt 2020 Annuity Trust IX(2)
Class A common stock 160,668 I Held by The Gregory R. Blatt 2020 Annuity Trust III(3)
Class A common stock 11/16/2021 J 76,923 D $0.00 0 I Held by Bald Eagle IV LLC(4)
Class A common stock 11/16/2021 J 76,923 A(5) $0.00 76,923 D
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 (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 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 (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (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: 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
Explanation of Responses:
1. These securities 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.
2. These securities 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.
3. These securities 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.
4. Held by Bald Eagle IV LLC. The Reporting Person is a member of Bald Eagle IV LLC. The Reporting Person disclaims beneficial ownership, within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of all securities held by Bald Eagle IV LLC in which the Reporting Person has no pecuniary interest.
5. Represents a pro-rata in kind distribution of the Class A common stock held by Bald Eagle IV LLC to the Reporting Person.
Remarks:
/s/ Rene Paula, attorney-in-fact for Gregory R. Blatt 11/18/2021
** 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 4 (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.
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