0000950103-19-003373.txt : 20190313 0000950103-19-003373.hdr.sgml : 20190313 20190313163021 ACCESSION NUMBER: 0000950103-19-003373 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: Papiernik Antoine CENTRAL INDEX KEY: 0001768408 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38829 FILM NUMBER: 19678570 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 dp103685_4-papiernik.xml FORM 4 X0306 4 2019-03-11 0 0001642545 ShockWave Medical, Inc. SWAV 0001768408 Papiernik Antoine C/O SHOCKWAVE MEDICAL, INC. 5403 BETSY ROSS DRIVE SANTA CLARA CA 95054 1 0 1 0 Common Stock 2019-03-11 4 C 0 2342911 A 2342911 I See Footnote Common Stock 2019-03-11 4 C 0 1108848 A 3451759 I See Footnote Common Stock 2019-03-11 4 C 0 592447 A 4044206 I See Footnote Series A-1 Convertible Preferred Stock 2019-03-11 4 C 0 2342911 A Common Stock 2342911 0 I See Footnote Series B Convertible Preferred Stock 2019-03-11 4 C 0 1108848 A Common Stock 1108848 0 I See Footnote Series C Convertible Preferred Stock 2019-03-11 4 C 0 592447 A Common Stock 592447 0 I See Footnote 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. Antoine Papiernik is one of the managing partners of Sofinnova Partners SAS, a French corporation and the management company of Sofinnova Capital VII FCPR. /s/ Trinh Phung, as attorney-in-fact for Antoine Papiernik 2019-03-13