SEC Form 4 · accession 0000899243-18-028108
Axonics Modulation Technologies, Inc. · AXNX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Shahzad Malik
Director · Other
Period of report
Nov 2, 2018
Accepted (ET)
Nov 2, 2018 · 7:48 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 ("Advent"). The reporting person, who is a member of the Issuer's board of directors, is a general partner of Advent, and disclaims beneficial ownership of the shares held by Advent except to the extent of his indirect pecuniary interest therein.
- F4Securities are held by Advent Life Sciences Fund II LP. Advent is the general partner of Advent Life Sciences Fund II LP and the reporting person, who is a member of the Issuer's board of directors, is a partner of Advent. The reporting person disclaims beneficial ownership of the shares held by Advent Life Sciences Fund II LP except to the extent of his respective indirect pecuniary interest therein.
- 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.