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