0001562180-19-002782.txt : 20190513 0001562180-19-002782.hdr.sgml : 20190513 20190513193936 ACCESSION NUMBER: 0001562180-19-002782 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190306 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 19820112 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 primarydocument.xml PRIMARY DOCUMENT X0306 4 2019-03-06 false 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001756399 Sama Rinda 26 TECHNOLOGY DRIVE IRVINE CA 92618 false true false false Chief Operating Officer Common Stock 2019-03-06 4 A false 4000.00 0.00 A 4000.00 I By Spouse Common Stock 220627.00 D Stock Option (Right to Buy) 19.91 2019-03-06 4 A false 6500.00 0.00 A 2028-03-30 Common Stock 6500.00 6500.00 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 March 6, 2020 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of March 6, 2020, 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