0000899243-20-022192.txt : 20200812 0000899243-20-022192.hdr.sgml : 20200812 20200812201001 ACCESSION NUMBER: 0000899243-20-022192 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200810 FILED AS OF DATE: 20200812 DATE AS OF CHANGE: 20200812 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tammenoms Bakker Juliet CENTRAL INDEX KEY: 0001431159 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 201096747 MAIL ADDRESS: STREET 1: LONGITUDE CAPITAL MANAGEMENT CO., LLC STREET 2: 800 EL CAMINO REAL, SUITE 220 CITY: MENLO PARK STATE: CA ZIP: 94025 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 2020-08-10 0 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001431159 Tammenoms Bakker Juliet 2740 SAND HILL RD 2ND FLOOR MENLO PARK CA 94025 1 0 0 0 Common Stock 2020-08-10 4 J 0 978000 0.00 D 1955333 I By Longitude Venture Partners III, L.P. Common Stock 2020-08-10 4 J 0 1026 0.00 A 1026 I See Footnote Common Stock 2020-08-10 4 J 0 2393 0.00 A 11560 D Represents a pro rata distribution, and not a purchase or sale, without additional consideration by Longitude Venture Partners III, L.P. ("Longitude Venture III") to its general and limited partners. These shares are held by Longitude Venture III. Longitude Capital Partners III, LLC ("Longitude Capital III") is the general partner of Longitude Venture III and may be deemed to have voting, investment and dispositive power over the shares held by Longitude Venture III. Patrick G. Enright ("Mr. Enright") and the Reporting Person are the managing members of Longitude Capital III and may be deemed to share voting, investment and dispositive power over the shares held by Longitude Venture III. Each of Longitude Capital III, Mr. Enright and the Reporting Person disclaims beneficial ownership of such shares except to the extent of its, his or her pecuniary interest therein. Represents a pro rata distribution, and not a purchase or sale, without additional consideration by Longitude Capital III to its members. These shares are held by a trust. The Reporting Person is the Investment Trustee of such trust and may be deemed to share voting and dispositive power with regard to the reported shares. The Reporting Person disclaims beneficial ownership of such shares except to the extent of her pecuniary interest therein. /s/ Juliet Tammenoms Bakker 2020-08-12