0000899243-19-028812.txt : 20191210 0000899243-19-028812.hdr.sgml : 20191210 20191210134300 ACCESSION NUMBER: 0000899243-19-028812 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: Pardo Geoff CENTRAL INDEX KEY: 0001756338 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 191277210 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 2019-11-21 1 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001756338 Pardo Geoff 26 TECHNOLOGY DRIVE IRVINE CA 92618 0 0 0 1 Former 10% Owner The reporting person is filing this exit Form 4 to reflect that he is no longer a 10% owner of the issuer. The ownership percentage of the reporting person 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/ Geoff Pardo 2019-12-10