0000950103-19-003372.txt : 20190313 0000950103-19-003372.hdr.sgml : 20190313 20190313162936 ACCESSION NUMBER: 0000950103-19-003372 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190311 FILED AS OF DATE: 20190313 DATE AS OF CHANGE: 20190313 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MOLL FREDERIC H CENTRAL INDEX KEY: 0001260157 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38829 FILM NUMBER: 19678555 MAIL ADDRESS: STREET 1: C/O INTUITIVE SURGICAL INC STREET 2: 950 KIFER ROAD CITY: SUNNYVALE STATE: CA ZIP: 94086 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ShockWave Medical, Inc. CENTRAL INDEX KEY: 0001642545 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 270494101 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 48501 WARM SPRINGS BLVD. STREET 2: STE. 108 CITY: FREMONT STATE: CA ZIP: 94539 BUSINESS PHONE: 510-279-4262 MAIL ADDRESS: STREET 1: 48501 WARM SPRINGS BLVD. STREET 2: STE. 108 CITY: FREMONT STATE: CA ZIP: 94539 4 1 dp103686_4-moll.xml X0306 4 2019-03-11 0 0001642545 ShockWave Medical, Inc. SWAV 0001260157 MOLL FREDERIC H C/O SHOCKWAVE MEDICAL, INC. 5403 BETSY ROSS DRIVE SANTA CLARA CA 95054 1 0 0 0 Common Stock 2019-03-11 4 C 0 123657 A 123657 D Common Stock 2019-03-11 4 C 0 114107 A 237764 D Common Stock 2019-03-11 4 C 0 28767 A 266531 D Common Stock 2019-03-11 4 C 0 24347 A 290878 D Series A Convertible Preferred Stock 2019-03-11 4 C 0 123657 A Common Stock 123657 0 D Series A-1 Convertible Preferred Stock 2019-03-11 4 C 0 114107 A Common Stock 114107 0 D Series B Convertible Preferred Stock 2019-03-11 4 C 0 28767 A Common Stock 28767 0 D Series C Convertible Preferred Stock 2019-03-11 4 C 0 24347 A Common Stock 24347 0 D Each share the convertible preferred stock automatically converted into shares of Common Stock on a one-for-one basis immediately upon the closing of the Issuer's initial public offering without payment or consideration. The shares of the convertible preferred stock had no expiration date. /s/ Trinh Phung, as attorney-in-fact for Frederic Moll 2019-03-13