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