0000950103-19-003369.txt : 20190313
0000950103-19-003369.hdr.sgml : 20190313
20190313162606
ACCESSION NUMBER: 0000950103-19-003369
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: WATKINS FRANK T
CENTRAL INDEX KEY: 0001305831
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38829
FILM NUMBER: 19678515
MAIL ADDRESS:
STREET 1: 5403 BETSY ROSS DRIVE
CITY: SANTA CLARA
STATE: CA
ZIP: 95054
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
dp103687_4-watkins.xml
FORM 4
X0306
4
2019-03-11
0
0001642545
ShockWave Medical, Inc.
SWAV
0001305831
WATKINS FRANK T
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
32295
A
32295
D
Common Stock
2019-03-11
4
C
0
14383
A
46678
D
Series A-1 Convertible Preferred Stock
2019-03-11
4
C
0
32295
A
Common Stock
32295
0
D
Series B Convertible Preferred Stock
2019-03-11
4
C
0
14383
A
Common Stock
14383
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 F.T. Jay Watkins
2019-03-13