0000899243-18-030619.txt : 20181210
0000899243-18-030619.hdr.sgml : 20181210
20181210211953
ACCESSION NUMBER: 0000899243-18-030619
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181206
FILED AS OF DATE: 20181210
DATE AS OF CHANGE: 20181210
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Pardo Geoff
CENTRAL INDEX KEY: 0001756338
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38721
FILM NUMBER: 181227656
MAIL ADDRESS:
STREET 1: 26 TECHNOLOGY DRIVE
CITY: IRVINE
STATE: CA
ZIP: 92618
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
2018-12-06
0
0001603756
Axonics Modulation Technologies, Inc.
AXNX
0001756338
Pardo Geoff
26 TECHNOLOGY DRIVE
IRVINE
CA
92618
1
0
1
0
Common Stock
2018-12-06
4
A
0
2500
0.00
A
2500
D
Common Stock
3133332
I
By Cooperatieve Gilde Healthcare IV U.A.
Stock Option (Right to Buy)
14.80
2018-12-06
4
A
0
5000
0.00
A
2028-12-06
Common Stock
5000
5000
D
The shares are held directly by Cooperatieve Gilde Healthcare IV U.A. ("Gilde"). The reporting person, who is a member of the Issuer's board of directors, is a partner of Gilde. Gilde is managed by Gilde Healthcare IV Management B.V. ("Management"). Management is owned by Gilde Healthcare Holding B.V. ("Holding"). Each of the reporting person, Management and Holding may be deemed to have voting, investment and dispositive power with respect to these securities. Each of the reporting person,
(Continued from Footnote 1) Management and Holding disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of their respective pecuniary interests therein.
The shares subject to the option will vest in full on April 30, 2019.
/s/ Michael V. Williamson, as Attorney-in-Fact for Geoff Pardo
2018-12-10