SEC Form 4 · accession 0000899243-19-002371
Axonics Modulation Technologies, Inc. · AXNX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Danny L. Dearen
Officer — See Remarks
Period of report
Jan 30, 2019
Accepted (ET)
Feb 1, 2019 · 9:34 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001603756
Table I — non-derivative securities
No Table I lines on this filing.
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)F1 | $14.19 | Jan 30, 2019 | A | 106,667 | A | — | Jan 30, 2029 | Common Stock | 106,667 | 106,667 | D |
| Performance-Based Restricted Stock UnitsF2 | $0.00 | Jan 30, 2019 | A | 8,000 | A | Jan 30, 2020 | — | Common Stock | 8,000 | 8,000 | D |
| Performance-Based Restricted Stock UnitsF3 | $0.00 | Jan 30, 2019 | A | 8,000 | A | Jan 30, 2021 | — | Common Stock | 8,000 | 8,000 | D |
Explanation of responses
- F1The option becomes exercisable as follows: (i) 1/4 of the total number of shares of common stock underlying the option will vest on January 30, 2020 and (ii) 1/36 of the remaining shares of common stock underlying the option will vest monthly thereafter, such that the option will fully vest on January 30, 2023, provided the reporting person remains in continuous service on each vesting date.
- F2Each Performance-Based Restricted Stock Unit represents the contingent right to receive one share of common stock, subject to the Issuer's achievement of certain operational and performance objectives during the fiscal year ending December 31, 2019 and provided the reporting person remains in continuous service through January 30, 2020.
- F3The number of Performance-Based Restricted Stock Units represents the target number of Performance-Based Restricted Stock Units that were granted to the reporting person on the date of grant, each of which represents the contingent right to receive one share of common stock, subject to the conditions set forth in the award agreement. Per the terms of the award agreement governing the Performance-Based Restricted Stock Units, the number of Performance-Based Restricted Stock Units to which the reporting person may ultimately become entitled ranges from 0% to 200% of the target number of Performance-Based Restricted Stock Units granted, based upon the total shareholder return of the Issuer's common stock relative to its peer group index over a performance period consisting of the two fiscal years ending December 31, 2020, and provided the reporting person remains in continuous service through January 30, 2021.
Remarks
President and Chief Financial Officer