0001562180-21-000567.txt : 20210127
0001562180-21-000567.hdr.sgml : 20210127
20210127200858
ACCESSION NUMBER: 0001562180-21-000567
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210126
FILED AS OF DATE: 20210127
DATE AS OF CHANGE: 20210127
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Ford Alfred J Jr
CENTRAL INDEX KEY: 0001359446
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38721
FILM NUMBER: 21561601
MAIL ADDRESS:
STREET 1: 3303 MONTE VILLA PARKWAY
CITY: BOTHELL
STATE: WA
ZIP: 98021
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
primarydocument.xml
PRIMARY DOCUMENT
X0306
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2021-01-26
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0001603756
Axonics Modulation Technologies, Inc.
AXNX
0001359446
Ford Alfred J Jr
26 TECHNOLOGY DRIVE
IRVINE
CA
92618
false
true
false
false
Chief Commercial Officer
Common Stock
2021-01-26
4
M
false
7065.00
0.00
A
7065.00
D
Common Stock
2021-01-26
4
S
false
2417.00
53.5766
D
4648.00
D
Performance-Based Restricted Stock Units
2021-01-26
4
M
false
7065.00
0.00
D
Common Stock
7065.00
0.00
D
Each Performance-Based Restricted Stock Unit represents the contingent right to receive one share of common stock, subject to the Issuer's achievement of certain operational and performance objectives during the fiscal year ending December 31, 2020 and provided the reporting person remains in continuous service through December 31, 2020.
Shares of Issuer's common stock sold to cover the reporting person's tax obligation in connection with the conversion of the Performance-Based Restricted Stock Units disclosed herein.
This transaction was executed in multiple trades at prices ranging from $53.14 to $53.96. The price reported above reflects the weighted average price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected.
/s/ Dan Dearen, as Attorney-in-Fact for Alfred J. Ford, Jr.
2021-01-27