SEC Form 4 · accession 0000899243-18-030616

Axonics Modulation Technologies, Inc. · AXNX

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director · 10% Owner

Period of report

Dec 6, 2018

Accepted (ET)

Dec 10, 2018 · 9:17 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 Stock^F1,F2	holding	—	—		—	2,933,333	I	By Longitude Venture Partners III, L.P.

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

F1These shares are held directly by Longitude Venture Partners III, L.P. ("Longitude Venture III"). Longitude Capital Partners III, LLC ("Longitude Capital III"), is the general partner of Longitude Venture III and may be deemed to have voting, investment and dispositive power with respect to these securities. Ms. Tammenoms Bakker, who is a member of the Issuer's board of directors, and Patrick G. Enright are the managing members of Longitude Capital III (each a "Manager" and collectively, the "Managers"), and may each be deemed to share voting, investment and dispositive power with respect to these securities. Each of Longitude Capital III and the Managers disclaims beneficial ownership of these securities and this report shall not be deemed an admission that any of them is the beneficial owner of such securities for purposes of Section 16 or for any other purpose,
F2(Continued from Footnote 1) except to the extent of their respective pecuniary interests therein.
F3The shares subject to the option will vest in full on April 30, 2019.