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Filing Details

Accession Number:: 0000899243-18-028094
Form Type:: 4
Zero Holdings:: No
Publication Time:: 2018-11-02 19:35:53
Reporting Period:: 2018-11-02

Accepted Time:: 2018-11-02 19:35:53
SEC Url:: Form 4 Filing

Issuer

Cik	Name	Symbol	Sector (SIC)	IRS No
1603756	Axonics Modulation Technologies Inc.	AXNX	()	4

Insiders

Cik	Name	Reported Address	Insider Title	Director	Officer	Large Shareholder	Other
1578307	Raphael Wisniewski	26 Technology Drive Irvine CA 92618		Yes	No	Yes	No

Reported Non-Derivative Transactions

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Sec. Name	Acquisiton - Disposition	Date	Amount	Price	Remaning Holdings	Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
Common Stock	Acquisiton	2018-11-02	799,228	$0.00	799,228	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2018-11-02	806,080	$0.00	1,605,308	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2018-11-02	431,250	$0.00	2,036,558	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2018-11-02	654,237	$0.00	2,690,795	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2018-11-02	866,666	$15.00	3,557,461	No	4	P	Indirect	See footnote

Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
No	4	C	Indirect	See footnote
No	4	C	Indirect	See footnote
No	4	C	Indirect	See footnote
No	4	C	Indirect	See footnote
No	4	P	Indirect	See footnote

Reported Derivative Transactions

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Sec. Name	Sec. Type	Acquisiton - Disposition	Date	Amount	Price	Amount - 2	Price - 2
Common Stock	Series A Preferred Stock	Disposition	2018-11-02	345,000	$0.00	799,228	$0.00
Common Stock	Series B-1 Preferred Stock	Disposition	2018-11-02	671,733	$0.00	806,080	$0.00
Common Stock	Series B-2 Preferred Stock	Disposition	2018-11-02	359,375	$0.00	431,250	$0.00
Common Stock	Series C Preferred Stock	Disposition	2018-11-02	545,197	$0.00	654,237	$0.00

Equity Swap Involved	Transaction Form Type	Transaction Code	Nature of Ownership
No	4	C	Indirect
No	4	C	Indirect
No	4	C	Indirect
No	4	C	Indirect

Footnotes

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 A preferred stock automatically converted into 2.31660 shares of the Issuer's common stock. The A preferred stock had no expiration date.
2,824,128 shares are held of record by BioDiscovery 4 FCPR ("BioDiscovery") and 733,333 shares are held of record by BioDiscovery 5 ("BioDiscovery 5"). Andera Partners ("Andera") is the manager of BioDiscovery and BioDiscovery 5 and may be deemed to have sole voting and dispositive power over the shares held by BioDiscovery and BioDiscovery 5. The reporting person is a director of the Issuer and is a partner of Andera, and may be deemed to share voting and dispositive power over the shares held by BioDiscovery and BioDiscovery 5. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
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-1 preferred stock automatically converted into 1.2 shares of the Issuer's common stock. The B-1 preferred stock had no expiration date.
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.
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.