0001562180-20-005776.txt : 20200902 0001562180-20-005776.hdr.sgml : 20200902 20200902194409 ACCESSION NUMBER: 0001562180-20-005776 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200831 FILED AS OF DATE: 20200902 DATE AS OF CHANGE: 20200902 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ford Alfred J Jr CENTRAL INDEX KEY: 0001359446 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 201158048 MAIL ADDRESS: STREET 1: 3303 MONTE VILLA PARKWAY CITY: BOTHELL STATE: WA ZIP: 98021 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 2020-08-31 false 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001359446 Ford Alfred J Jr 26 TECHNOLOGY DRIVE IRVINE CA 92618 false true false false Chief Commercial Officer Common Stock 2020-08-31 4 S false 2667.00 42.3116 D 0.00 D Common Stock 2020-09-02 4 M false 35000.00 1.42 A 35000.00 D Common Stock 2020-09-02 4 S false 11031.00 39.8447 D 23969.00 D Common Stock 2020-09-02 4 S false 23743.00 40.4062 D 226.00 D Common Stock 2020-09-02 4 S false 226.00 41.3229 D 0.00 D Stock Option (Right to Buy) 1.42 2020-09-02 4 M false 35000.00 0.00 D 2027-11-15 Common Stock 35000.00 23380.00 D This transaction was executed in multiple trades at prices ranging from $42.31 to $42.3401. The price reported above reflects the weighted average price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected. This transaction was executed in multiple trades at prices ranging from $39.21 to $40.20. The price reported above reflects the weighted average price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected. This transaction was executed in multiple trades at prices ranging from $40.21 to $40.91. The price reported above reflects the weighted average price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected. This transaction was executed in multiple trades at prices ranging from $41.23 to $41.35. The price reported above reflects the weighted average price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected. The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on November 15, 2017 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of November 15, 2017, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable. /s/ Dan Dearen, as Attorney-in-Fact for Alfred J. Ford, Jr. 2020-09-02