0001603756-18-000001.txt : 20180412 0001603756-18-000001.hdr.sgml : 20180412 20180412160612 ACCESSION NUMBER: 0001603756-18-000001 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20180412 DATE AS OF CHANGE: 20180412 EFFECTIVENESS DATE: 20180412 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Axonics Modulation Technologies, Inc. CENTRAL INDEX KEY: 0001603756 IRS NUMBER: 454744083 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-286592 FILM NUMBER: 18752175 BUSINESS ADDRESS: STREET 1: 7575 IRVINE CENTER DRIVE, SUITE 200 CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: 949-396-6322 MAIL ADDRESS: STREET 1: 7575 IRVINE CENTER DRIVE, SUITE 200 CITY: IRVINE STATE: CA ZIP: 92618 D/A 1 primary_doc.xml X0708 D/A LIVE 0001603756 Axonics Modulation Technologies, Inc. 7575 IRVINE CENTER DRIVE, SUITE 200 IRVINE CA CALIFORNIA 92618 949-396-6322 DELAWARE American Restorative Medicine, Inc. None Corporation true Raymond W. Cohen 7575 Irvine Center Drive, Suite 200 Irvine CA CALIFORNIA 92618 Executive Officer Director Dan L. Dearen 7575 Irvine Center Drive, Suite 200 Irvine CA CALIFORNIA 92618 Executive Officer Michael Williamson 7575 Irvine Center Drive, Suite 200 Irvine CA CALIFORNIA 92618 Executive Officer Raphael Wisniewski 7575 Irvine Center Drive, Suite 200 Irvine CA CALIFORNIA 92618 Director John Petrovich 7575 Irvine Center Drive, Suite 200 Irvine CA CALIFORNIA 92618 Director Erik Amble 7575 Irvine Center Drive, Suite 200 Irvine CA CALIFORNIA 92618 Director Shahzad Malik 7575 Irvine Center Drive, Suite 200 Irvine CA CALIFORNIA 92618 Director Geoff Pardo 7575 Irvine Center Drive, Suite 200 Irvine CA CALIFORNIA 92618 Director Juliet Tammenoms Bakker 7575 Irvine Center Drive, Suite 200 Irvine CA CALIFORNIA 92618 Director Other Technology Decline to Disclose 06b true 0001603756-17-000001 2017-04-28 false true false 0 55099998 55099998 0 false 17 0 0 0 false Axonics Modulation Technologies, Inc. /s/Raymond W. Cohen Raymond W. Cohen Chief Executive Officer 2018-04-11