0001562180-19-004194.txt : 20190806 0001562180-19-004194.hdr.sgml : 20190806 20190806175721 ACCESSION NUMBER: 0001562180-19-004194 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190806 FILED AS OF DATE: 20190806 DATE AS OF CHANGE: 20190806 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: COHEN RAYMOND W CENTRAL INDEX KEY: 0001258288 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 191003327 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 2019-08-06 false 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001258288 COHEN RAYMOND W 26 TECHNOLOGY DRIVE IRVINE CA 92618 true true false false Chief Executive Officer Common Stock 2019-08-06 4 P false 3500.00 30.4111 A 683391.00 D Common Stock 692151.00 I See footnote 8,760 shares are held of record by Cielo Trust Established March 30, 2018 and 683,391 shares are held of record by the reporting person. /s/ Michael V. Williamson, as Attorney-in-Fact for Raymond W. Cohen 2019-08-06