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