0001437749-24-023598.txt : 20240726 0001437749-24-023598.hdr.sgml : 20240726 20240726160658 ACCESSION NUMBER: 0001437749-24-023598 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240618 FILED AS OF DATE: 20240726 DATE AS OF CHANGE: 20240726 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Robins David Andrew CENTRAL INDEX KEY: 0002007950 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-41940 FILM NUMBER: 241146840 MAIL ADDRESS: STREET 1: C/O AUTONOMIX MEDICAL, INC. STREET 2: 21 WATERWAY AVENUE, SUITE 300 CITY: THE WOODLANDS STATE: TX ZIP: 77380 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 rdgdoc.xml FORM 4 - ROBINS D. X0508 4 2024-06-18 0001617867 Autonomix Medical, Inc. AMIX 0002007950 Robins David Andrew 21 WATERWAY AVENUE SUITE 300 THE WOODLANDS TX 77380 1 0 Warrant (Right to buy) 0.001 2024-06-18 4 P 0 103990 0.001 A 2029-01-29 Common Stock 103990 110240 I See footnote Includes a portion of 1,600,000 warrants to purchase shares of the Company's common stock that was held by Impulse Medical, Inc., in which Mr. Robins owns 19.5% through Portsmouth Therapeutics, Inc., an entity in which Mr. Robins also owns a 33.33% interest. The shares underlying the warrants are subject to a lockup agreement for a period of six months after January 29, 2024 with respect to 12.5% of the shares issued and twelve months after January 29, 2024 for the remainder of the shares. /s/ Trent Smith, Attorney-in-Fact for David Robins 2024-07-26