SEC Form 4 · accession 0000899243-18-030610
Axonics Modulation Technologies, Inc. · AXNX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Shahzad Malik
Director
Period of report
Dec 6, 2018
Accepted (ET)
Dec 10, 2018 · 9:12 pm EST
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 Stock | Dec 6, 2018 | A | 2,500 | $0.00 | A | 2,500 | D | |
| Common StockF1 | holding | — | — | — | 58,234 | I | By Advent Life Sciences LLP | |
| Common StockF2 | holding | — | — | — | 1,636,115 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F3 | $14.80 | Dec 6, 2018 | A | 5,000 | A | — | Dec 6, 2028 | Common Stock | 5,000 | 5,000 | D |
Explanation of responses
- F1Securities 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.
- F2Securities 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.
- F3The shares subject to the option will vest in full on April 30, 2019.