SEC Form 4 · accession 0000899243-18-030611
Axonics Modulation Technologies, Inc. · AXNX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
John George Petrovich
Director
Period of report
Dec 6, 2018
Accepted (ET)
Dec 10, 2018 · 9:13 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 | — | — | — | 2,102,970 | I | See footnote |
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)F2 | $14.80 | Dec 6, 2018 | A | 5,000 | A | — | Dec 6, 2028 | Common Stock | 5,000 | 5,000 | D |
Explanation of responses
- F1These securities are held by The Alfred E. Mann Foundation for Scientific Research. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose.
- F2The shares subject to the option will vest in full on April 30, 2019.