SEC Form 4 · accession 0000899243-18-028107
Axonics Modulation Technologies, Inc. · AXNX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Period of report
Nov 2, 2018
Accepted (ET)
Nov 2, 2018 · 7:45 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,F2,F3 | Nov 2, 2018 | C | 43,822 | — | A | 43,822 | I | By Advent Life Sciences LLP |
| Common StockF1,F2,F4 | Nov 2, 2018 | C | 1,231,178 | — | A | 1,275,000 | I | By Advent Life Sciences Fund II LP |
| Common StockF1,F5,F3 | Nov 2, 2018 | C | 14,412 | — | A | 1,289,412 | I | By Advent Life Sciences LLP |
| Common StockF1,F5,F4 | Nov 2, 2018 | C | 404,937 | — | A | 1,694,349 | I | By Advent Life Sciences Fund II LP |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series B-2 Preferred StockF3,F2,F1 | — | Nov 2, 2018 | C | 36,518 | D | — | — | Common Stock | 43,822 | 0 | I |
| Series B-2 Preferred StockF4,F2,F1 | — | Nov 2, 2018 | C | 1,025,981 | D | — | — | Common Stock | 1,231,178 | 0 | I |
| Series C Preferred StockF3,F5,F1 | — | Nov 2, 2018 | C | 12,010 | D | — | — | Common Stock | 14,412 | 0 | I |
| Series C Preferred StockF4,F5,F1 | — | Nov 2, 2018 | C | 337,447 | D | — | — | Common Stock | 404,937 | 0 | I |
Explanation of responses
- F1Reflects a 1.2-for-1 forward stock split of the Issuer's common stock effected on October 18, 2018.
- F2Effective 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.
- F3Securities are held by Advent Life Sciences LLP.
- F4Securities are held by Advent Life Sciences Fund II LP. Advent Life Sciences LLP is the general partner of Advent Life Sciences Fund II LP.
- F5Effective 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.