0000899243-19-028818.txt : 20191210
0000899243-19-028818.hdr.sgml : 20191210
20191210150414
ACCESSION NUMBER: 0000899243-19-028818
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191121
FILED AS OF DATE: 20191210
DATE AS OF CHANGE: 20191210
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gilde Healthcare Holding B.V.
CENTRAL INDEX KEY: 0001420106
STATE OF INCORPORATION: P7
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38721
FILM NUMBER: 191277522
BUSINESS ADDRESS:
STREET 1: NEWTONLAAN 91
STREET 2: PO BOX 85067
CITY: 3508 UTRECHT
STATE: P7
ZIP: AB
BUSINESS PHONE: 31(0)30-2192549
MAIL ADDRESS:
STREET 1: NEWTONLAAN 91
STREET 2: PO BOX 85067
CITY: 3508 UTRECHT
STATE: P7
ZIP: AB
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gilde Healthcare IV Management B.V.
CENTRAL INDEX KEY: 0001757508
STATE OF INCORPORATION: P7
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38721
FILM NUMBER: 191277523
BUSINESS ADDRESS:
STREET 1: NEWTONLAAN 91
CITY: UTRECHT
STATE: P7
ZIP: 3584 BP
BUSINESS PHONE: 949-396-6322
MAIL ADDRESS:
STREET 1: NEWTONLAAN 91
CITY: UTRECHT
STATE: P7
ZIP: 3584 BP
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Cooperatieve Gilde Healthcare IV U.A.
CENTRAL INDEX KEY: 0001756335
STATE OF INCORPORATION: P7
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38721
FILM NUMBER: 191277524
BUSINESS ADDRESS:
STREET 1: NEWTONLANN 51
CITY: UTRECHT
STATE: P7
ZIP: 3508AB
BUSINESS PHONE: 949-396-6322
MAIL ADDRESS:
STREET 1: NEWTONLANN 51
CITY: UTRECHT
STATE: P7
ZIP: 3508AB
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
doc4.xml
FORM 4 SUBMISSION
X0306
4
2019-11-21
1
0001603756
Axonics Modulation Technologies, Inc.
AXNX
0001420106
Gilde Healthcare Holding B.V.
NEWTONLAAN 91 3584 BP UTRECHT
THE NETHERLANDS
0
0
0
1
Former 10% Owner
0001757508
Gilde Healthcare IV Management B.V.
NEWTONLAAN 91 3584 BP UTRECHT
THE NETHERLANDS
0
0
0
1
Former 10% Owner
0001756335
Cooperatieve Gilde Healthcare IV U.A.
NEWTONLAAN 91 3584 BP UTRECHT
THE NETHERLANDS
0
0
0
1
Former 10% Owner
The reporting persons are filing this exit Form 4 to reflect that they are no longer a 10% owner of the issuer. The ownership percentage of the reporting persons is based on the number of shares reported by the issuer to be outstanding immediately after the closing of the issuer's offering on the issuer's prospectus filed with the Securities and Exchange Commission on November 21, 2019.
/s/ M.O.J.M. Perret, Managing Director
2019-12-10