0000899243-18-027748.txt : 20181030
0000899243-18-027748.hdr.sgml : 20181030
20181030213333
ACCESSION NUMBER: 0000899243-18-027748
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20181030
FILED AS OF DATE: 20181030
DATE AS OF CHANGE: 20181030
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Advent Life Sciences LLP
CENTRAL INDEX KEY: 0001601364
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38721
FILM NUMBER: 181148519
BUSINESS ADDRESS:
STREET 1: 158 NORTH GOWER STREET
CITY: LONDON
STATE: X0
ZIP: NW1 2ND
BUSINESS PHONE: 44 (0) 207 932 2120
MAIL ADDRESS:
STREET 1: 158 NORTH GOWER STREET
CITY: LONDON
STATE: X0
ZIP: NW1 2ND
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Advent Life Sciences Fund II LP
CENTRAL INDEX KEY: 0001614918
STATE OF INCORPORATION: X0
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38721
FILM NUMBER: 181148520
BUSINESS ADDRESS:
STREET 1: 158-160 NORTH GOWER STREET
CITY: LONDON
STATE: X0
ZIP: NW1 2ND
BUSINESS PHONE: 44 207 932 2100
MAIL ADDRESS:
STREET 1: 158-160 NORTH GOWER STREET
CITY: LONDON
STATE: X0
ZIP: NW1 2ND
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
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2018-10-30
0
0001603756
Axonics Modulation Technologies, Inc.
AXNX
0001601364
Advent Life Sciences LLP
158 NORTH GOWER STREET
LONDON
X0
NW1 2nd
UNITED KINGDOM
0
0
1
0
0001614918
Advent Life Sciences Fund II LP
158 NORTH GOWER STREET
LONDON
X0
NW1 2nd
UNITED KINGDOM
0
0
1
0
Series B-2 Preferred Stock
Common Stock
43822
I
By Advent Life Sciences LLP
Series B-2 Preferred Stock
Common Stock
1231178
I
By Advent Life Sciences Fund II LP
Series C Preferred Stock
Common Stock
14412
I
By Advent Life Sciences LLP
Series C Preferred Stock
Common Stock
404937
I
By Advent Life Sciences Fund II LP
Each share of Series B-2 preferred stock is convertible, at any time, at the reporting person's election, into shares of the Issuer's common stock at the then-effective conversion rate for no additional consideration in accordance with the Issuer's Fourth Amended and Restated Certificate of Incorporation, as amended to date. In addition, effective upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of the Series B-2 preferred stock will automatically convert into 1.2 shares of the Issuer's common stock. The Series B-2 preferred stock has no expiration date.
Reflects a 1.2-for-1 forward stock split of the Issuer's common stock effected on October 18, 2018.
Securities are held by Advent Life Sciences LLP.
Securities are held by Advent Life Sciences Fund II LP. Advent Life Sciences LLP is the general partner of Advent Life Sciences Fund II LP.
Each share of Series C preferred stock is convertible, at any time, at the reporting person's election, into shares of the Issuer's common stock at the then-effective conversion rate for no additional consideration in accordance with the Issuer's Fourth Amended and Restated Certificate of Incorporation, as amended to date. In addition, effective upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of the Series C preferred stock will automatically convert into 1.2 shares of the Issuer's common stock. The Series C preferred stock has no expiration date.
/s/ Shahzad Malik, General Partner, Advent Life Sciences LLP
2018-10-30
/s/ Shahzad Malik, General Partner of Advent Life Sciences LLP, acting in its capacity as Manager of Advent Life Sciences Fund II LP
2018-10-30