Filing Details

Accession Number:
0000899243-18-028098
Form Type:
4
Zero Holdings:
No
Publication Time:
2018-11-02 19:40:03
Reporting Period:
2018-11-02
Accepted Time:
2018-11-02 19:40:03
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1603756 Axonics Modulation Technologies Inc. AXNX Surgical & Medical Instruments & Apparatus (3841) 454744083
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1756321 Fcpr 4 Biodiscovery 374 Rue Saint St Honore St.
75001 Paris
No No Yes No
1757283 Partners Andera 374 Rue Saint St Honore St.
75001 Paris
No No Yes No
Reported Non-Derivative Transactions
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
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
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
0 No 4 C Indirect
0 No 4 C Indirect
0 No 4 C Indirect
0 No 4 C Indirect
Footnotes
  1. Reflects a 1.2-for-1 forward stock split of the Issuer's common stock effected on October 18, 2018.
  2. 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.
  3. This report is filed jointly by Andera Partners ("Andera") and BioDiscovery 4 FCPR ("BioDiscovery"). 2,824,128 shares are held of record by BioDiscovery and 733,333 shares are held of record by BioDiscovery 5 ("BioDiscovery 5"). 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.
  4. 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.
  5. 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.
  6. 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.