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 4 2021-01-26 false 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