SEC Form 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
|C/O SHOCKWAVE MEDICAL, INC.|
|5403 BETSY ROSS DRIVE|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
Shockwave Medical, Inc.
[ SWAV ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||Form filed by One Reporting Person
||Form filed by More than One Reporting Person
|Table I - Non-Derivative Securities Beneficially Owned|
|1. Title of Security (Instr.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
|No securities are beneficially owned.|
||/s/ Wade Estey, as attorney-in-fact for Kevin J. Ballinger
||** Signature of Reporting Person
|Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.|
|* If the form is filed by more than one reporting person,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).|
|Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
Instruction 6 for procedure.|
|Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.|
POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby constitutes and appoints
each of Douglas Godshall, Daniel Puckett, Trinh Phung and Wade Estey as the
undersigneds true and lawful attorneys-in-fact to:
(1) execute for and on behalf of the undersigned, in the undersigneds capacity
reporting person pursuant to Section 16 of the Securities Exchange Act of 1934,
as amended (the "Exchange Act"), and the rules thereunder of Shockwave
Medical, Inc. (the "Company"), Forms 3, 4 and 5 in accordance with Section
16(a) of the Exchange Act;
(2) do and perform any and all acts for and on behalf of the undersigned which
be necessary or desirable to complete and execute any such Form 3, 4 or 5 and
timely file such form with the United States Securities and Exchange
Commission and stock exchange or similar authority; and
(3) take any other action of any type whatsoever in connection with the
which, in the opinion of any of such attorneys-in-fact, may be of benefit to, in
best interest of, or legally required by, the undersigned, it being understood
the documents executed by any of such attorneys-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as any of such attorneys-in-fact may approve
in the discretion of any of such attorneys-in-fact.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that any of such attorneys-in-fact, or the
substitute or substitutes of any of such attorneys-in-fact, shall lawfully do or
cause to be done by virtue of this Power of Attorney and the rights and powers
herein granted. The undersigned acknowledges that the foregoing
attorneys-in-fact, in serving in such capacity at the request of the
undersigned, are not assuming, nor is the Company assuming, any of the
undersigneds responsibilities to comply with Section 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to the
undersigneds holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 9th day of May 2023.
Signature: /s/ Kevin Ballinger
Print Name: Kevin Ballinger