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