0001562180-19-002781.txt : 20190513 0001562180-19-002781.hdr.sgml : 20190513 20190513193350 ACCESSION NUMBER: 0001562180-19-002781 CONFORMED SUBMISSION TYPE: 3/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181030 FILED AS OF DATE: 20190513 DATE AS OF CHANGE: 20190513 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Sama Rinda CENTRAL INDEX KEY: 0001756399 FILING VALUES: FORM TYPE: 3/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 19820103 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 3/A 1 primarydocument.xml PRIMARY DOCUMENT X0206 3/A 2018-10-30 2018-10-30 0 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001756399 Sama Rinda 26 TECHNOLOGY DRIVE IRVINE CA 92618 false true false false Chief Operating Officer Stock Options (Right to buy) 0.97 2024-06-29 Common Stock 1800.00 I By Spouse Stock Options (Right to buy) 0.97 2025-04-01 Common Stock 1800.00 I By Spouse Stock Options (Right to buy) 0.98 2026-01-15 Common Stock 7472.00 I By Spouse Stock Options (Right to buy) 1.32 2027-05-22 Common Stock 1870.00 I By Spouse Stock Options (Right to buy) 1.32 2027-07-05 Common Stock 1040.00 I By Spouse Stock Options (Right to buy) 1.42 2027-08-25 Common Stock 1892.00 I By Spouse Stock Options (Right to buy) 1.63 2028-03-30 Common Stock 4200.00 I By Spouse The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on June 30, 2015 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of June 30, 2015, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable. These options were omitted from the reporting person's original Form 3. The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on April 2, 2016 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of April 2, 2016, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable. The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on January 15, 2017 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of January 15, 2017, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable. The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on May 23, 2018 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of May 23, 2018, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable. The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on July 5, 2018 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of July 5, 2018, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable. The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on July 21, 2018 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of July 21, 2018, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable. The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on March 30, 2019 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of March 30, 2019, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable. /s/ Michael V. Williamson, as Attorney-in-Fact for Rinda Sama 2019-05-10