SEC Form 3 · accession 0000899243-18-027721
Axonics Modulation Technologies, Inc. · AXNX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Rinda Sama
Officer — Chief Operating Officer
Period of report
Oct 30, 2018
Accepted (ET)
Oct 30, 2018 · 9:14 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001603756
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | holding | — | — | — | 220,627 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F1,F2 | $1.63 | holding | — | — | — | — | Mar 30, 2028 | Common Stock | 25,200 | — | D |
Explanation of responses
- F1Reflects a 1.2-for-1 forward stock split of the Issuer's common stock effected on October 18, 2018.
- F2The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on March 30, 2018 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of March 30, 2018, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable.
Remarks
Exhibit List: Exhibit 24.1 - Power of Attorney