0001104659-24-073596.txt : 20240620 0001104659-24-073596.hdr.sgml : 20240620 20240620202325 ACCESSION NUMBER: 0001104659-24-073596 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240618 FILED AS OF DATE: 20240620 DATE AS OF CHANGE: 20240620 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BioStar Ventures III, L.P. CENTRAL INDEX KEY: 0001577164 ORGANIZATION NAME: STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41940 FILM NUMBER: 241058126 BUSINESS ADDRESS: STREET 1: 206 BRIDGE STREET CITY: CHARLEVOIX STATE: MI ZIP: 49720 BUSINESS PHONE: (231) 437-7622 MAIL ADDRESS: STREET 1: 206 BRIDGE STREET CITY: CHARLEVOIX STATE: MI ZIP: 49720 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Autonomix Medical, Inc. CENTRAL INDEX KEY: 0001617867 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] ORGANIZATION NAME: 08 Industrial Applications and Services IRS NUMBER: 471607810 STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 BUSINESS ADDRESS: STREET 1: 21 WATERWAY AVENUE, SUITE 300 CITY: THE WOODLANDS STATE: TX ZIP: 77380 BUSINESS PHONE: 832-277-7816 MAIL ADDRESS: STREET 1: 21 WATERWAY AVENUE, SUITE 300 CITY: THE WOODLANDS STATE: TX ZIP: 77380 4 1 tm2417717-1_4seq1.xml OWNERSHIP DOCUMENT X0508 4 2024-06-18 0 0001617867 Autonomix Medical, Inc. AMIX 0001577164 BioStar Ventures III, L.P. 206 BRIDGE STREET CHARLEVOIX MI 49720 0 0 1 0 0 Warrant to Purchase Common Stock 0.001 2024-06-18 4 P 0 1088000 0.028 A 2029-01-29 Common Stock 1088000 1088000 D The ability of the Reporting Person to exercise the warrants is subject to a beneficial ownership limitation initially set at 4.99% of the number of shares of common stock outstanding immediately after giving effect to the issuance of common stock issuable upon exercise of the warrants. This beneficial ownership limitation may be increased or decreased at the election of the holder, provided that the beneficial ownership limitation in no event exceeds 9.99% of the number of shares of common stock outstanding immediately after giving effect to the issuance of shares of common stock upon exercise of the warrants and any increase shall not be effective until the 61st day after notice of adjustment is provided to the Issuer. BioStar Ventures III, L.P. By: BioStar Ventures III, L.L.C. Its: General Partner /s/ Louis Cannon, MD Name: Louis Cannon, MD Title: Founder, Senior Managing Director 2024-06-20