0001603756-14-000001.txt : 20140331
0001603756-14-000001.hdr.sgml : 20140331
20140331125915
ACCESSION NUMBER: 0001603756-14-000001
CONFORMED SUBMISSION TYPE: D
PUBLIC DOCUMENT COUNT: 1
ITEM INFORMATION: 06b
FILED AS OF DATE: 20140331
DATE AS OF CHANGE: 20140331
EFFECTIVENESS DATE: 20140331
FILER:
COMPANY DATA:
COMPANY CONFORMED NAME: Axonics Modulation Technologies, Inc.
CENTRAL INDEX KEY: 0001603756
IRS NUMBER: 454744083
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: D
SEC ACT: 1933 Act
SEC FILE NUMBER: 021-214560
FILM NUMBER: 14728900
BUSINESS ADDRESS:
STREET 1: 16411 SCIENTIFIC WAY, STE 200
CITY: IRVINE
STATE: CA
ZIP: 92618
BUSINESS PHONE: (949)396-6322
MAIL ADDRESS:
STREET 1: 16411 SCIENTIFIC WAY, STE 200
CITY: IRVINE
STATE: CA
ZIP: 92618
D
1
primary_doc.xml
X0707
D
LIVE
0001603756
Axonics Modulation Technologies, Inc.
16411 SCIENTIFIC WAY, STE 200
IRVINE
CA
CALIFORNIA
92618
(949)396-6322
DELAWARE
American Restorative Medicine, Inc.
None
Corporation
true
2012
Raymond
W.
Cohen
16411 SCIENTIFIC WAY, STE 200
IRVINE
CA
CALIFORNIA
92618
Executive Officer
Director
Dan
L.
Dearen
16411 SCIENTIFIC WAY, STE 200
IRVINE
CA
CALIFORNIA
92618
Executive Officer
Michael
V.
Williamson
16411 SCIENTIFIC WAY, STE 200
IRVINE
CA
CALIFORNIA
92618
Executive Officer
Robert
Guezuraga
16411 SCIENTIFIC WAY, STE 200
IRVINE
CA
CALIFORNIA
92618
Director
David
Hankin
16411 SCIENTIFIC WAY, STE 200
IRVINE
CA
CALIFORNIA
92618
Director
Raphael
Wisniewski
47, rue du Faubourg Saint-Honore
75401 Paris
Cedex
I0
FRANCE
08
Director
John
G.
Petrovich
25134 Rye Canyon Loop #200
Santa Clarita
CA
CALIFORNIA
91355
Director
Other Technology
Decline to Disclose
- 06b
false
2014-03-14
false
true
true
false
200000
35000000
13500000
21500000
false
6
0
0
800000
false
Axonics Modulation Technologies, Inc.
/s/: Michael V. Williamson
Michael V. Williamson
Secretary
2014-03-25