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