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Filing Details

Accession Number:: 0000899243-18-028098
Form Type:: 4
Zero Holdings:: No
Publication Time:: 2018-11-02 19:40:03
Reporting Period:: 2018-11-02

Accepted Time:: 2018-11-02 19:40:03
SEC Url:: Form 4 Filing

Issuer

Cik	Name	Symbol	Sector (SIC)	IRS No
1603756	Axonics Modulation Technologies Inc.	AXNX	Surgical & Medical Instruments & Apparatus (3841)	454744083

Insiders

Cik	Name	Reported Address	Insider Title	Director	Officer	Large Shareholder	Other
1756321	Fcpr 4 Biodiscovery	374 Rue Saint St Honore St. 75001 Paris		No	No	Yes	No
1757283	Partners Andera	374 Rue Saint St Honore St. 75001 Paris		No	No	Yes	No

Reported Non-Derivative Transactions

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Sec. Name	Acquisiton - Disposition	Date	Amount	Price	Remaning Holdings	Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
Common Stock	Acquisiton	2018-11-02	799,228	$0.00	799,228	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2018-11-02	806,080	$0.00	1,605,308	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2018-11-02	431,250	$0.00	2,036,558	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2018-11-02	654,237	$0.00	2,690,795	No	4	C	Indirect	See footnote
Common Stock	Acquisiton	2018-11-02	866,666	$15.00	3,557,461	No	4	P	Indirect	See footnote

Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
No	4	C	Indirect	See footnote
No	4	C	Indirect	See footnote
No	4	C	Indirect	See footnote
No	4	C	Indirect	See footnote
No	4	P	Indirect	See footnote

Reported Derivative Transactions

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Sec. Name	Sec. Type	Acquisiton - Disposition	Date	Amount	Price	Amount - 2	Price - 2
Common Stock	Series A Preferred Stock	Disposition	2018-11-02	345,000	$0.00	799,228	$0.00
Common Stock	Series B-1 Preferred Stock	Disposition	2018-11-02	671,733	$0.00	806,080	$0.00
Common Stock	Series B-2 Preferred Stock	Disposition	2018-11-02	359,375	$0.00	431,250	$0.00
Common Stock	Series C Preferred Stock	Disposition	2018-11-02	545,197	$0.00	654,237	$0.00

Equity Swap Involved	Transaction Form Type	Transaction Code	Nature of Ownership
No	4	C	Indirect
No	4	C	Indirect
No	4	C	Indirect
No	4	C	Indirect

Footnotes

Reflects a 1.2-for-1 forward stock split of the Issuer's common stock effected on October 18, 2018.
Effective upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of Series A preferred stock automatically converted into 2.31660 shares of the Issuer's common stock. The A preferred stock had no expiration date.
This report is filed jointly by Andera Partners ("Andera") and BioDiscovery 4 FCPR ("BioDiscovery"). 2,824,128 shares are held of record by BioDiscovery and 733,333 shares are held of record by BioDiscovery 5 ("BioDiscovery 5"). Andera is the manager of BioDiscovery and BioDiscovery 5 and may be deemed to have sole voting and dispositive power over the shares held by BioDiscovery and BioDiscovery 5.
Effective upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of Series B-1 preferred stock automatically converted into 1.2 shares of the Issuer's common stock. The B-1 preferred stock had no expiration date.
Effective upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of Series B-2 preferred stock automatically converted into 1.2 shares of the Issuer's common stock. The B-2 preferred stock had no expiration date.
Effective upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of Series C preferred stock automatically converted into 1.2 shares of the Issuer's common stock. The C preferred stock had no expiration date.