0001562180-19-004489.txt : 20190826 0001562180-19-004489.hdr.sgml : 20190826 20190826185835 ACCESSION NUMBER: 0001562180-19-004489 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190822 FILED AS OF DATE: 20190826 DATE AS OF CHANGE: 20190826 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MCNAMARA ROBERT E CENTRAL INDEX KEY: 0001361535 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 191054034 MAIL ADDRESS: STREET 1: C/O NORTHSTAR NEUROSCIENCE, INC. STREET 2: 2401 FOURTH AVENUE, SUITE 300 CITY: SEATTLE STATE: WA ZIP: 98121 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 2019-08-22 false 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001361535 MCNAMARA ROBERT E 26 TECHNOLOGY DRIVE IRVINE CA 92618 true false false false Common Stock 2019-08-22 4 A false 5000.00 0.00 A 13167.00 D Stock Option (Right to Buy) 34.10 2019-08-22 4 A false 10000.00 0.00 A 2029-08-22 Common Stock 10000.00 10000.00 D The shares subject to the option will vest in full on August 18, 2020. /s/ Michael V. Williamson, as Attorney-in-Fact for Robert E. McNamara 2019-08-26