0000899243-18-027758.txt : 20181030 0000899243-18-027758.hdr.sgml : 20181030 20181030213852 ACCESSION NUMBER: 0000899243-18-027758 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181030 FILED AS OF DATE: 20181030 DATE AS OF CHANGE: 20181030 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Longitude Capital Partners III, LLC CENTRAL INDEX KEY: 0001713663 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 181148530 BUSINESS ADDRESS: STREET 1: 800 EL CAMINO, SUITE 220 CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-845-5700 MAIL ADDRESS: STREET 1: 800 EL CAMINO, SUITE 220 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ENRIGHT PATRICK G CENTRAL INDEX KEY: 0001253886 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 181148531 MAIL ADDRESS: STREET 1: CO LONGITUDE CAPITAL PARTNERS LLC STREET 2: 800 EL CAMINO REAL, SUITE 220 CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Longitude Venture Partners III, L.P. CENTRAL INDEX KEY: 0001674099 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 181148532 BUSINESS ADDRESS: STREET 1: 800 EL CAMINO REAL, SUITE 220 CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-845-5700 MAIL ADDRESS: STREET 1: 800 EL CAMINO REAL, SUITE 220 CITY: MENLO PARK STATE: CA ZIP: 94025 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 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2018-10-30 0 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001713663 Longitude Capital Partners III, LLC 2740 SAND HILL RD 2ND FLOOR MENLO PARK CA 94025 0 0 1 0 0001253886 ENRIGHT PATRICK G 2740 SAND HILL RD 2ND FLOOR MENLO PARK CA 94025 0 0 1 0 0001674099 Longitude Venture Partners III, L.P. 2740 SAND HILL ROAD, 2ND FLOOR MENLO PARK CA 94025 0 0 1 0 Series C Preferred Stock Common Stock 2400000 I By Longitude Venture Partners III, L.P. Each share of Series C preferred stock is convertible, at any time, at the holder's election, into shares of the Issuer's common stock at the then-effective conversion rate for no additional consideration in accordance with the Issuer's Fourth Amended and Restated Certificate of Incorporation, as amended to date. In addition, effective upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of the Series C preferred stock will automatically convert into 1.2 shares of the Issuer's common stock. The Series C preferred stock has no expiration date. Reflects a 1.2-for-1 forward stock split of the Issuer's common stock effected on October 18, 2018. These shares are held directly by Longitude Venture Partners III, L.P. ("Longitude Venture III"). Longitude Capital Partners III, LLC ("Longitude Capital III") is the general partner of Longitude Venture III and may be deemed to have voting, investment and dispositive power with respect to these securities. Patrick G. Enright and Juliet Tammenoms Bakker, a member of the Issuer's board of directors, are the managing members of Longitude Capital III (each a "Manager" and collectively, the "Managers") and may each be deemed to share voting, investment and dispositive power with respect to these securities. Each of Longitude Capital III and the Managers disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their respective pecuniary interests therein. /s/ Patrick G. Enright, Managing Member of Longitude Capital Partners III, LLC 2018-10-30 /s/ Patrick G. Enright 2018-10-30 /s/ Patrick G. Enright, Managing Member of Longitude Capital Partners III, LLC, General Partner of Longitude Venture Partners III, L.P. 2018-10-30