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