0000899243-18-028107.txt : 20181102 0000899243-18-028107.hdr.sgml : 20181102 20181102194542 ACCESSION NUMBER: 0000899243-18-028107 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181102 FILED AS OF DATE: 20181102 DATE AS OF CHANGE: 20181102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Advent Life Sciences LLP CENTRAL INDEX KEY: 0001601364 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 181158482 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38721 FILM NUMBER: 181158483 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-11-02 1 0001603756 Axonics Modulation Technologies, Inc. AXNX 0001601364 Advent Life Sciences LLP 158 NORTH GOWER STREET LONDON X0 NW1 2nd UNITED KINGDOM 0 0 0 1 Former 10% Owner 0001614918 Advent Life Sciences Fund II LP 158 NORTH GOWER STREET LONDON X0 NW1 2nd UNITED KINGDOM 0 0 0 1 Former 10% Owner Common Stock 2018-11-02 4 C 0 43822 A 43822 I By Advent Life Sciences LLP Common Stock 2018-11-02 4 C 0 1231178 A 1275000 I By Advent Life Sciences Fund II LP Common Stock 2018-11-02 4 C 0 14412 A 1289412 I By Advent Life Sciences LLP Common Stock 2018-11-02 4 C 0 404937 A 1694349 I By Advent Life Sciences Fund II LP Series B-2 Preferred Stock 2018-11-02 4 C 0 36518 0.00 D Common Stock 43822 0 I By Advent Life Sciences LLP Series B-2 Preferred Stock 2018-11-02 4 C 0 1025981 0.00 D Common Stock 1231178 0 I By Advent Life Sciences Fund II LP Series C Preferred Stock 2018-11-02 4 C 0 12010 0.00 D Common Stock 14412 0 I By Advent Life Sciences LLP Series C Preferred Stock 2018-11-02 4 C 0 337447 0.00 D Common Stock 404937 0 I By Advent Life Sciences Fund II LP Reflects a 1.2-for-1 forward stock split of the Issuer's common stock effected on October 18, 2018. 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 Series B-2 preferred stock automatically converted into 1.2 shares of the Issuer's common stock. The B-2 preferred stock had no expiration date. 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. 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 Series C preferred stock automatically converted into 1.2 shares of the Issuer's common stock. The C preferred stock had no expiration date. /s/ Shahzad Malik, General Partner, Advent Life Sciences LLP 2018-11-02 /s/ Shahzad Malik, General Partner of Advent Life Sciences LLP, acting in its capacity as Manager of Advent Life Sciences Fund II LP 2018-11-02