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