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