0000899243-18-030611.txt : 20181210 0000899243-18-030611.hdr.sgml : 20181210 20181210211303 ACCESSION NUMBER: 0000899243-18-030611 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181206 FILED AS OF DATE: 20181210 DATE AS OF CHANGE: 20181210 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Petrovich John George CENTRAL INDEX KEY: 0001387382 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 181227636 MAIL ADDRESS: STREET 1: CALANDO PHARMACEUTICALS INC. STREET 2: 2585 NINA STREET CITY: PASADENA STATE: CA ZIP: 91107 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 doc4.xml FORM 4 SUBMISSION X0306 4 2018-12-06 0 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001387382 Petrovich John George 26 TECHNOLOGY DRIVE IRVINE CA 92618 1 0 0 0 Common Stock 2018-12-06 4 A 0 2500 0.00 A 2500 D Common Stock 2102970 I See footnote Stock Option (Right to Buy) 14.80 2018-12-06 4 A 0 5000 0.00 A 2028-12-06 Common Stock 5000 5000 D These securities are held by The Alfred E. Mann Foundation for Scientific Research. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. The shares subject to the option will vest in full on April 30, 2019. /s/ Michael V. Williamson, as Attorney-in-Fact for John George Petrovich 2018-12-10