# EDGAR Filing Document

**Accession Number:** 0001809613
**File Stem:** 0001104659-23-028617
**Filing Date:** 2023-3
**Character Count:** 7029
**Document Hash:** 7a07db06deb2647a77cf68c1a8363157
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001104659-23-028617.hdr.sgml**: 20230303

**ACCESSION NUMBER**: 0001104659-23-028617

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230302

**FILED AS OF DATE**: 20230303

**DATE AS OF CHANGE**: 20230303

**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:** 23707120

**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:** 303 SOUTH BROADWAY, SUITE 125
- **CITY:** TARRYTOWN
- **STATE:** NY
- **ZIP:** 10591
- **BUSINESS PHONE:** 914-987-2876

**MAIL ADDRESS:**
- **STREET 1:** 303 SOUTH BROADWAY, SUITE 125
- **CITY:** TARRYTOWN
- **STATE:** NY
- **ZIP:** 10591

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Derby Michael<br><sub>(Last) (First) (Middle)</sub><br>C/O PAXMEDICA, INC.<br>303 SOUTH BROADWAY, SUITE 125<br><sub>(Street)</sub><br>TARRYTOWN, NY 10591<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-03-02 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [X] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_Executive Chairman_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>PaxMedica, Inc. [ PXMD ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2023-03-02 |  | S<sup>(1)</sup> |  | 10497 | D | 1.94<sup>(2)</sup> | 374503 | D |  |
| Common Stock | 2023-03-03 |  | S<sup>(1)</sup> |  | 18968 | D | 1.90<sup>(3)</sup> | 355535 | D |  |
| Common Stock |  |  |  |  |  |  |  | 7336745 | I | TardiMed Sciences, LLC<sup>(4)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |

---

### Footnotes:

(1) The sales reported in this Form 4 were effected pursuant to the Reporting Person's pre-existing Rule 10b5-1 trading plan. Shares were sold by the Reporting Person to generate proceeds used to satisfy the tax withholding obligation that arose upon the vesting of restricted stock units granted to the Reporting Person.

(2) This sale price represents the weighted average sale price of the shares sold ranging from $2.09 to $1.87 per share. Upon request by the Commission staff, the Issuer, or a security holder of the Issuer, the Reporting Person will provide full information regarding the number of shares sold at each separate price within the range set forth in this Form 4.

(3) This sale price represents the weighted average sale price of the shares sold ranging from $1.98 to $1.84 per share. Upon request by the Commission staff, the Issuer, or a security holder of the Issuer, the Reporting Person will provide full information regarding the number of shares sold at each separate price within the range set forth in this Form 4.

(4) 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.

**Signature:** /s/ Stephen D. Sheldon, Jr. Attorney-in-Fact  
**Date:** 2023-03-03

### Remarks:

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.

**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.**