0001603756-15-000003.txt : 20151221
0001603756-15-000003.hdr.sgml : 20151221
20151221135353
ACCESSION NUMBER: 0001603756-15-000003
CONFORMED SUBMISSION TYPE: D
PUBLIC DOCUMENT COUNT: 1
ITEM INFORMATION: 06b
FILED AS OF DATE: 20151221
DATE AS OF CHANGE: 20151221
EFFECTIVENESS DATE: 20151221
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: 021-253511
FILM NUMBER: 151299102
BUSINESS ADDRESS:
STREET 1: 7575 IRVINE CENTER DRIVE, SUITE 200
CITY: IRVINE
STATE: CA
ZIP: 92618
BUSINESS PHONE: 949-396-6322
MAIL ADDRESS:
STREET 1: 7575 IRVINE CENTER DRIVE, SUITE 200
CITY: IRVINE
STATE: CA
ZIP: 92618
D
1
primary_doc.xml
X0707
D
LIVE
0001603756
Axonics Modulation Technologies, Inc.
7575 IRVINE CENTER DRIVE, SUITE 200
IRVINE
CA
CALIFORNIA
92618
949-396-6322
DELAWARE
American Restorative Medicine, Inc.
None
Corporation
true
2012
Raymond
W.
Cohen
7575 Irvine Center Drive, Suite 200
Irvine
CA
CALIFORNIA
92618
Executive Officer
Director
Dan
L.
Dearen
7575 Irvine Center Drive, Suite 200
Irvine
CA
CALIFORNIA
92618
Executive Officer
Michael
Williamson
7575 Irvine Center Drive, Suite 200
Irvine
CA
CALIFORNIA
92618
Executive Officer
Raphael
Wisniewski
7575 Irvine Center Drive, Suite 200
Irvine
CA
CALIFORNIA
92618
Director
Barry
Keenan
7575 Irvine Center Drive, Suite 200
Irvine
CA
CALIFORNIA
92618
Director
John
Petrovich
7575 Irvine Center Drive, Suite 200
Irvine
CA
CALIFORNIA
92618
Director
Darren
Cai
7575 Irvine Center Drive, Suite 200
Irvine
CA
CALIFORNIA
92618
Director
Erik
Amble
7575 Irvine Center Drive, Suite 200
Irvine
CA
CALIFORNIA
92618
Director
Shahzad
Malik
7575 Irvine Center Drive, Suite 200
Irvine
CA
CALIFORNIA
92618
Director
Other Technology
Decline to Disclose
- 06b
false
2015-12-04
false
true
false
0
38512857
38512857
0
false
14
0
0
0
false
Axonics Modulation Technologies, Inc.
/s/Michael Williamson
Michael Williamson
Sr. Vice President
2015-12-18