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