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
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2020-01-30
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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