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