SEC FORM 4/A 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*
Yednock Ted

(Last) (First) (Middle)
C/O ANNEXON, INC.
1400 SIERRA POINT PKWY, BLDG C, STE 200

(Street)
BRISBANE CA 94005

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Annexon, Inc. [ ANNX ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP & Chief Innovation Officer
3. Date of Earliest Transaction (Month/Day/Year)
07/11/2023
4. If Amendment, Date of Original Filed (Month/Day/Year)
12/29/2023
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Rule 10b5-1(c) Transaction Indication

X
Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.
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
Common Stock(1) 07/11/2023 S(2) 1,057 D $3.8361(3) 37,885(4) D
Common Stock 12/27/2023 M(5) 10,615 A $1.4096 48,500(4)(6) D
Common Stock 12/27/2023 M(5) 10,385 A $1.8501 58,885(4)(6) D
Common Stock 12/27/2023 S(5) 21,000 D $4.5222(3) 37,885(4)(6) D
Common Stock(7) 21,000(7) I By Spouse
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. Late reporting of transaction being made as a result of an administrative oversight.
2. The shares were sold to cover tax withholding obligations in connection with the vesting of restricted stock units ("RSUs").
3. This transaction was executed in multiple trades in prices ranging from $3.72 to $3.90, inclusive. The price reported in Column 4 above reflects the weighted average sale price. The Reporting Person hereby undertakes to provide to the Securities and Exchange Commission staff, the Issuer, or a security holder of the Issuer, upon request, full information regarding the number of shares sold at each respective price within the range set forth in this footnote.
4. Includes 33,559 restricted stock units.
5. The transactions reported herein were effected pursuant to the Reporting Person's Rule 10b5-1 trading plan, adopted March 28, 2023.
6. Column 5 is being amended to reflect the correct amount of securities beneficially owned following reported transaction.
7. Reflects the correct amount of securities beneficially owned that was unintentionally omitted from the Form 4 filed December 29, 2023.
Remarks:
On December 29, 2023, the reporting person filed a Form 4 that inadvertently omitted to report the reporting person's (1) shares of common stock that were sold to cover tax withholding obligations in connection with the vesting of restricted stock units and (2) then current Column 5 holdings of common stock beneficially owned, as initially reported by the reporting person on Form 3. This amendment reports the correct amount of securities beneficially owned.
/s/ Jennifer Lew, as Attorney-in-Fact 01/23/2024
** 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.
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.