0001562180-19-003722.txt : 20190701 0001562180-19-003722.hdr.sgml : 20190701 20190701185145 ACCESSION NUMBER: 0001562180-19-003722 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190627 FILED AS OF DATE: 20190701 DATE AS OF CHANGE: 20190701 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Amble Erik CENTRAL INDEX KEY: 0001756337 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 19934706 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 2019-06-27 false 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001756337 Amble Erik 26 TECHNOLOGY DRIVE IRVINE CA 92618 true false false false Common Stock 2019-06-27 4 A false 1667.00 0.00 A 4167.00 D Common Stock 1520884.00 I By NeoMed Innovation V, L.P. Stock Option (Right to Buy) 37.15 2019-06-27 4 A false 5000.00 0.00 A 2029-06-27 Common Stock 5000.00 5000.00 D These shares are held of record by NeoMed Innovation V, L.P. ("NeoMed"). NeoMed Innovation V Limited is the general partner of NeoMed and has voting and dispositive power over the shares held by NeoMed. Erik Amble, Ph.D., who is a member of the Issuer's board of directors, is a director of NeoMed Innovation V Limited, and may be deemed to have voting and dispositive power over the shares held by NeoMed. Mr. Amble disclaims beneficial ownership of these securities and this report shall not be deemed an admission that Mr. Amble is the beneficial owner of such securities for purposes of Section 16 or for any other purpose, except to the extent of his respective pecuniary interest therein. The shares subject to the option will vest in full on August 19, 2019. /s/ Michael V. Williamson, as Attorney-in-Fact for Erik Amble, Ph.D. 2019-07-01