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
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2019-06-27
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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