0001562180-20-000789.txt : 20200203 0001562180-20-000789.hdr.sgml : 20200203 20200203210359 ACCESSION NUMBER: 0001562180-20-000789 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200130 FILED AS OF DATE: 20200203 DATE AS OF CHANGE: 20200203 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: 20570406 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 2020-01-30 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 2020-01-30 4 M false 5667.00 0.00 A 206294.00 D Common Stock 4000.00 I By Spouse Performance-Based Restricted Stock Units 0.00 2020-01-30 4 M false 5667.00 0.00 D 2020-01-30 Common Stock 5667.00 0.00 D All of the Performance Based Restricted Stock Units vested on January 30, 2020. /s/ Dan Dearen, as Attorney-in-Fact for Rinda Sama 2020-02-03