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