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