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