0000899243-19-006285.txt : 20190305
0000899243-19-006285.hdr.sgml : 20190305
20190305193057
ACCESSION NUMBER: 0000899243-19-006285
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190227
FILED AS OF DATE: 20190305
DATE AS OF CHANGE: 20190305
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: CARREL MICHAEL H
CENTRAL INDEX KEY: 0001230584
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38721
FILM NUMBER: 19660714
MAIL ADDRESS:
STREET 1: 6217 CENTRE PARK DR
CITY: WEST CHESTER
STATE: OH
ZIP: 45069
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Axonics Modulation Technologies, Inc.
CENTRAL INDEX KEY: 0001603756
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 454744083
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 26 TECHNOLOGY DRIVE
CITY: IRVINE
STATE: CA
ZIP: 92618
BUSINESS PHONE: 949-396-6322
MAIL ADDRESS:
STREET 1: 26 TECHNOLOGY DRIVE
CITY: IRVINE
STATE: CA
ZIP: 92618
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2019-02-27
0
0001603756
Axonics Modulation Technologies, Inc.
AXNX
0001230584
CARREL MICHAEL H
26 TECHNOLOGY DRIVE
IRVINE
CA
92618
1
0
0
0
Common Stock
2019-02-27
4
A
0
5000
0.00
A
5000
D
Stock Option (Right to Buy)
20.85
2019-02-27
4
A
0
10000
0.00
A
2029-02-27
Common Stock
10000
10000
D
The option becomes exercisable in full on February 27, 2020, provided the reporting person remains in continuous service through such date.
/s/ Michael V. Williamson, as Attorney-in-Fact for Michael H. Carrel
2019-03-05