0000899243-19-002372.txt : 20190201
0000899243-19-002372.hdr.sgml : 20190201
20190201213501
ACCESSION NUMBER: 0000899243-19-002372
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190130
FILED AS OF DATE: 20190201
DATE AS OF CHANGE: 20190201
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Sama Rinda
CENTRAL INDEX KEY: 0001756399
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38721
FILM NUMBER: 19561481
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
2019-01-30
0
0001603756
Axonics Modulation Technologies, Inc.
AXNX
0001756399
Sama Rinda
26 TECHNOLOGY DRIVE
IRVINE
CA
92618
0
1
0
0
Chief Operating Officer
Stock Option (Right to Buy)
14.19
2019-01-30
4
A
0
75555
0.00
A
2029-01-30
Common Stock
75555
75555
D
Performance-Based Restricted Stock Units
0.00
2019-01-30
4
A
0
5667
0.00
A
2020-01-30
Common Stock
5667
5667
D
Performance-Based Restricted Stock Units
0.00
2019-01-30
4
A
0
5667
0.00
A
2021-01-30
Common Stock
5667
5667
D
The option becomes exercisable as follows: (i) 1/4 of the total number of shares of common stock underlying the option will vest on January 30, 2020 and (ii) 1/36 of the remaining shares of common stock underlying the option will vest monthly thereafter, such that the option will fully vest on January 30, 2023, provided the reporting person remains in continuous service on each vesting date.
Each Performance-Based Restricted Stock Unit represents the contingent right to receive one share of common stock, subject to the Issuer's achievement of certain operational and performance objectives during the fiscal year ending December 31, 2019 and provided the reporting person remains in continuous service through January 30, 2020.
The number of Performance-Based Restricted Stock Units represents the target number of Performance-Based Restricted Stock Units that were granted to the reporting person on the date of grant, each of which represents the contingent right to receive one share of common stock, subject to the conditions set forth in the award agreement. Per the terms of the award agreement governing the Performance-Based Restricted Stock Units, the number of Performance-Based Restricted Stock Units to which the reporting person may ultimately become entitled ranges from 0% to 200% of the target number of Performance-Based Restricted Stock Units granted, based upon the total shareholder return of the Issuer's common stock relative to its peer group index over a performance period consisting of the two fiscal years ending December 31, 2020, and provided the reporting person remains in continuous service through January 30, 2021.
/s/ Michael V. Williamson, as Attorney-in-Fact for Rinda Sama
2019-02-01