SEC FORM 3

SEC Form 3

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

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1. Name and Address of Reporting Person^*

Rogers Erica J.

(Last)

(First)

(Middle)

C/O SILK ROAD MEDICAL, INC.

1213 INNSBRUCK DRIVE

(Street)

SUNNYVALE

94089

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
04/03/2019

3. Issuer Name and Ticker or Trading Symbol
Silk Road Medical Inc [ SILK ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
X	Officer (give title below)	Other (specify below)
	President and CEO

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	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. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	96,296	D
Common Stock	73,694	I	See Footnote⁽¹⁾

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Series C Preferred Stock	⁽²⁾	⁽²⁾	Common Stock	9,012	⁽²⁾	I	See Footnote⁽¹⁾
Employee Stock Option (Right to buy)	⁽³⁾	12/14/2022	Common Stock	204,110	$1.38	D
Employee Stock Option (Right to buy)	⁽³⁾	12/24/2024	Common Stock	61,728	$1.46	D
Employee Stock Option (Right to buy)	⁽⁴⁾	12/03/2025	Common Stock	143,290	$1.6	D
Employee Stock Option (Right to buy)	⁽⁵⁾	08/04/2026	Common Stock	259,259	$1.6	D
Employee Stock Option (Right to buy)	⁽⁶⁾	11/30/2027	Common Stock	74,074	$6.11	D
Employee Stock Option (Right to buy)	⁽⁶⁾	11/30/2027	Common Stock	366,666	$12.15	D
Employee Stock Option (Right to buy)	⁽⁷⁾	11/30/2027	Common Stock	22,222	$12.15	D
Employee Stock Option (Right to buy)	⁽³⁾	09/30/2026	Common Stock	330	$8.27	D
Series C Preferred Stock Warrant (Right to buy)	⁽⁸⁾	10/13/2023	Common Stock	1,638	$6.11	I	See Footnote⁽⁹⁾

Explanation of Responses:

1. These shares are held directly by Kevin J. Surace and Erica J. Rogers, as Trustees of The Surace/Rogers Family Trust (the "Surace/Rogers Family Trust").

2. The Series C Preferred Stock shall automatically convert into Common Stock on a 1:1 basis immediately prior to the completion of the Issuer's initial public offering of Common Stock and has no expiration date.

3. All of the shares subject to this option are fully vested and exercisable as of the date hereof.

4. One forty-eighth of the shares subject to the option vested on January 3, 2016 and one forty-eighth of the shares subject to the option vest each month thereafter, subject to the Reporting Person continuing as a service provider through each such date.

5. One forty-eighth of the shares subject to the option vested on September 4, 2016 and one forty-eighth of the shares subject to the option vest each month thereafter, subject to the Reporting Person continuing as a service provider through each such date.

6. One forty-eighth of the shares subject to the option vested on September 1, 2017 and one forty-eighth of the shares subject to the option vest each month thereafter, subject to the Reporting Person continuing as a service provider through each such date.

7. All of the shares subject to the option shall vest upon the earlier of a change in control of the Issuer or the two year anniversary of the initial public offering of the Issuer's Common Stock, subject to the Reporting Person continuing as a service provider through such date.

8. All of the shares subject to this warrant are fully vested and exercisable as of the date hereof.

9. This warrant is held by the Surace/Rogers Family Trust.

Remarks:

Exhibit 24 - Power of Attorney

	/s/ Mhairi Jones, by power of attorney	04/03/2019
	** Signature of Reporting Person	Date
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, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 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, see Instruction 6 for procedure.
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