SEC Form 4 · accession 0000899243-18-030619
Axonics Modulation Technologies, Inc. · AXNX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Geoff Pardo
Director · 10% Owner
Period of report
Dec 6, 2018
Accepted (ET)
Dec 10, 2018 · 9:19 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,F2 | holding | — | — | — | 3,133,332 | I | By Cooperatieve Gilde Healthcare IV U.A. |
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
- F1The shares are held directly by Cooperatieve Gilde Healthcare IV U.A. ("Gilde"). The reporting person, who is a member of the Issuer's board of directors, is a partner of Gilde. Gilde is managed by Gilde Healthcare IV Management B.V. ("Management"). Management is owned by Gilde Healthcare Holding B.V. ("Holding"). Each of the reporting person, Management and Holding may be deemed to have voting, investment and dispositive power with respect to these securities. Each of the reporting person,
- F2(Continued from Footnote 1) Management and Holding 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, except to the extent of their respective pecuniary interests therein.
- F3The shares subject to the option will vest in full on April 30, 2019.