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*
Antibody Investments LLC

(Last) (First) (Middle)
7 HARTOM STREET, 2ND FLOOR, HAR HOTZVIM

(Street)
JERUSALEM L3 9777507

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/09/2018
3. Issuer Name and Ticker or Trading Symbol
VACCINEX, INC. [ VCNX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 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)
Form filed by One Reporting Person
X 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
Series C Convertible Preferred Stock (1) (1) Common Stock 1,346,139 (1) D
Series D Convertible Preferred Stock (2) (2) Common Stock 549,444 (2) D
1. Name and Address of Reporting Person*
Antibody Investments LLC

(Last) (First) (Middle)
7 HARTOM STREET, 2ND FLOOR, HAR HOTZVIM

(Street)
JERUSALEM L3 9777507

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Shumacher Michael

(Last) (First) (Middle)
7 HARTOM STREET, 2ND FLOOR, HAR HOTZVIM

(Street)
JERUSALEM L3 9777507

(City) (State) (Zip)
Explanation of Responses:
1. The reported securities will convert into shares of Common Stock on a 0.1868-for-1 basis immediately prior to the consummation of the Issuer's initial public offering.
2. The reported securities will convert into shares of Common Stock on a 1-for-10 basis immediately prior to the consummation of the Issuer's initial public offering.
Remarks:
Michael Shumacher is the sole manager of Antibody Investments LLC. Mr. Shumacher disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein.
ANTIBODY INVESTMENTS LLC By: /s/ Michael Shumacher, Manager 08/09/2018
/s/ Michael Shumacher 08/09/2018
** 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).
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