0001562180-20-005677.txt : 20200826 0001562180-20-005677.hdr.sgml : 20200826 20200826201738 ACCESSION NUMBER: 0001562180-20-005677 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200824 FILED AS OF DATE: 20200826 DATE AS OF CHANGE: 20200826 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: 201138767 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 2020-08-24 false 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001756337 Amble Erik 26 TECHNOLOGY DRIVE IRVINE CA 92618 true false false false Common Stock 2020-08-24 4 A false 3500.00 0.00 A 12667.00 D Common Stock 1520884.00 I By NeoMed Innovation V, L.P. 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. /s/ Dan Dearen, as Attorney-in-Fact for Erik Amble, Ph.D. 2020-08-26