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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| C/O VACCINEX, INC. |
| 1895 MOUNT HOPE AVE. |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
03/14/2024
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3. Issuer Name and Ticker or Trading Symbol
VACCINEX, INC.
[ VCNX ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| Interim CFO |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Stock Option (Right to Buy) |
|
03/28/2033 |
Common Stock |
76 |
83.9 |
D |
|
| Stock Option (Right to Buy) |
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04/02/2032 |
Common Stock |
38 |
270.9 |
D |
|
| Stock Option (Right to Buy) |
|
04/02/2031 |
Common Stock |
19 |
615.3 |
D |
|
| Stock Option (Right to Buy) |
|
04/04/2030 |
Common Stock |
19 |
802.2 |
D |
|
| Stock Option (Right to Buy) |
|
08/30/2029 |
Common Stock |
9 |
1,205.4 |
D |
|
| Stock Option (Right to Buy) |
|
01/27/2029 |
Common Stock |
9 |
1,045.8 |
D |
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| Explanation of Responses: |
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|
/s/ Jill Sanchez |
03/14/2024 |
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** 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. |
Jill Sanchez
Limited Power of Attorney for Section 16 Reporting Obligations
Know all by these presents, that the undersigned hereby
constitutes and appoints Maurice Zauderer as the
undersigned's true and lawful attorney-in-fact, with full
power of substitution and authority to:
(1) execute for and on behalf of the undersigned, in
the undersigned's capacity as an officer and/or director
of Vaccinex, Inc. (the "Company"), Forms 3, 4 and 5 in
accordance with Section 16(a) of the Securities Exchange
Act of 1934 and the rules thereunder, as amended from
time to time (the "Exchange Act");
(2) do and perform any and all acts for and on behalf of
the undersigned that may be necessary or desirable to
complete and execute any such Form 3, 4 or 5, including any
amendment or amendments thereto, and timely file such form
with the United States Securities and Exchange Commission
and any 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 Limited Power of Attorney shall be in such form and
shall contain such information and disclosure as such
attorney-in-fact may approve in such attorney-in-fact's
discretion.
The undersigned hereby grants to each attorney-in-fact
full power and authority to do and perform any and every
act and thing whatsoever requisite, necessary or desirable
to be done in the exercise of any of the rights and powers
herein granted, as fully and 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 such attorney-in-fact's substitute or substitutes, shall
lawfully do or cause to be done by virtue of this Limited
Power of Attorney and the rights and powers herein granted.
The undersigned acknowledges that this Limited Power of
Attorney authorizes, but does not require each
attorney-in-fact to act in his discretion on information
provided to him without independent verification of such
information and further acknowledges that the foregoing
attorneys-in-fact, in serving in such capacity at the request
of the undersigned, are not assuming, nor is the Company
assuming, any of the undersigned's responsibilities to comply
with Section 16 of the Exchange Act.
This Limited Power of Attorney shall remain in full
force and effect until the undersigned is no longer required
to file Forms 4 and 5 under Section 16(a) of the Exchange Act
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 to the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has signed this Limited
Power of Attorney this 7th day of March 2024.
/s/ Jill Sanchez
Jill Sanchez
