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