0001567619-21-003192.txt : 20210211
0001567619-21-003192.hdr.sgml : 20210211
20210211192437
ACCESSION NUMBER: 0001567619-21-003192
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210209
FILED AS OF DATE: 20210211
DATE AS OF CHANGE: 20210211
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: WILSON KAREN J
CENTRAL INDEX KEY: 0001267490
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39990
FILM NUMBER: 21621813
MAIL ADDRESS:
STREET 1: C/O JAZZ PHARMACEUTICALS PLC
STREET 2: 5TH FL, WATERLOO EXCHANGE, WATERLOO RD
CITY: DUBLIN L2 4
STATE: L2
ZIP: 0
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Angion Biomedica Corp.
CENTRAL INDEX KEY: 0001601485
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 113430072
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 51 CHARLES LINDBERGH BOULEVARD
CITY: UNIONDALE
STATE: NY
ZIP: 11553
BUSINESS PHONE: (415) 655-4899
MAIL ADDRESS:
STREET 1: 51 CHARLES LINDBERGH BOULEVARD
CITY: UNIONDALE
STATE: NY
ZIP: 11553
4
1
doc1.xml
FORM 4
X0306
4
2021-02-09
0
0001601485
Angion Biomedica Corp.
ANGN
0001267490
WILSON KAREN J
C/O ANGION BIOMEDICA CORP.
51 CHARLES LINDBERGH BLVD.
UNIONDALE
NY
11553
1
0
0
0
Common Stock
2021-02-09
4
C
0
18718
11.57
A
18718
D
Convertible Promissory Note
16.00
2021-02-09
4
C
0
216569.87
0.00
D
Common Stock
216569.87
0
D
The convertible promissory note converted immediately prior to the consummation of the IPO into Common Stock.
The convertible promissory note ("Convertible Note") had a maturity date of June 1, 2021 and the principal amount of the Convertible Note converted upon the closing of the IPO into Common Shares at a conversion price equal to $18.00 per Common Share.
/s/ Jennifer J. Rhodes, as attorney-in fact for Karen J. Wilson
2021-02-11