0001562180-20-001262.txt : 20200214 0001562180-20-001262.hdr.sgml : 20200214 20200214215530 ACCESSION NUMBER: 0001562180-20-001262 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191231 FILED AS OF DATE: 20200214 DATE AS OF CHANGE: 20200214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: COHEN RAYMOND W CENTRAL INDEX KEY: 0001258288 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 20623113 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 5 1 primarydocument.xml PRIMARY DOCUMENT X0306 5 2019-12-31 false 0 0 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001258288 COHEN RAYMOND W 26 TECHNOLOGY DRIVE IRVINE CA 92618 true true false false Chief Executive Officer Common Stock 2019-01-06 5 G false 3000.00 0.00 D 622058.00 D Common Stock 2019-06-04 5 G false 50000.00 0.00 D 572058.00 D Common Stock 2019-06-18 5 G false 15000.00 0.00 D 557058.00 D Common Stock 2019-06-19 5 G false 15000.00 0.00 D 542058.00 D /s/ Dan Dearen, as Attorney-in-Fact for Raymond W. Cohen 2020-02-14