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AXONICS MODULATION
TECHNOLOGIES, INC.
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Common Stock, $0.0001 par value per share
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05465P101
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Raphaël Wisniewski
BioDiscovery 4 FCPR
374 Rue Saint-Honore
Paris 75001
949-396-6322
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January 22, 2020
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*
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The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which
would alter disclosures provided in a prior cover page.
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CUSIP No. 05465P101
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SCHEDULE 13D
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1
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NAMES OF REPORTING PERSON:
Andera Partners
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSON (ENTITIES ONLY):
Not applicable.
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS):
(a) ☐ (b) ☒
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3
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SEC USE ONLY:
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4
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SOURCE OF FUNDS (SEE INSTRUCTIONS):
OO
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5
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CHECK IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) OR 2(e): ☐
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6
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CITIZENSHIP OR PLACE OF ORGANIZATION:
France
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
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7
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SOLE VOTING POWER:
0
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8
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SHARED VOTING POWER:
2,957,461(1)
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9
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SOLE DISPOSITIVE POWER:
0
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10
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SHARED DISPOSITIVE POWER:
2,957,461(1)
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON:
2,957,461(1)
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12
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CHECK IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS): ☐
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13
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11):
8.7%(2)
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14
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS):
OO
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(1)
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2,224,128 shares are held of record by FCPR (as defined below) and 733,333 shares are held of record by BioDiscovery 5 (as defined below). Andera (as defined below) is the manager of FCPR and BioDiscovery 5, and may
be deemed to have voting, investment and dispositive power with respect to these securities. Wisniewski (as defined below) is a director of the Issuer (as defined below) and is a partner of
Andera, and may be deemed to share voting and dispositive power over the shares held by FCPR and BioDiscovery 5.
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(2)
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Based on 33,978,911 shares of Common Stock (as defined below) outstanding as of December 12, 2019, based on the information reported by the Issuer in its Form 8-K filed with the Securities and Exchange Commission (the
“Commission”) on December 12, 2019.
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CUSIP No. 05465P101
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SCHEDULE 13D
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1
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NAMES OF REPORTING PERSON:
BioDiscovery 4 FCPR
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSON (ENTITIES ONLY):
Not applicable.
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||||
2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS):
(a) ☐ (b) ☒
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||||
3
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SEC USE ONLY:
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||||
4
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SOURCE OF FUNDS (SEE INSTRUCTIONS):
OO
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5
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CHECK IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) OR 2(e): ☐
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6
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CITIZENSHIP OR PLACE OF ORGANIZATION:
France
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
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7
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SOLE VOTING POWER:
0
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8
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SHARED VOTING POWER:
2,224,128(1)
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9
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SOLE DISPOSITIVE POWER:
0
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10
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SHARED DISPOSITIVE POWER:
2,224,128(1)
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON:
2,224,128(1)
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12
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CHECK IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS): ☒
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13
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11):
6.6%(2)
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14
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS):
OO
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(1)
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Andera is the manager of FCPR and may be deemed to have voting, investment and dispositive power with respect to these securities. Wisniewski is a director of the
Issuer and is a partner of Andera, and may be deemed to share voting and dispositive power over the shares held by FCPR.
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(2)
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Based on 33,978,911 shares of Common Stock outstanding as of December 12, 2019, based on the information reported by the Issuer in its Form 8-K filed with the Commission on December 12, 2019.
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1
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NAMES OF REPORTING PERSON:
BioDiscovery 5
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSON (ENTITIES ONLY):
Not applicable.
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||||
2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS):
(a) ☐ (b) ☒
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||||
3
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SEC USE ONLY:
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||||
4
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SOURCE OF FUNDS (SEE INSTRUCTIONS):
OO
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5
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CHECK IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) OR 2(e): ☐
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6
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CITIZENSHIP OR PLACE OF ORGANIZATION:
France
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
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7
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SOLE VOTING POWER:
0
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8
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SHARED VOTING POWER:
733,333(1)
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9
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SOLE DISPOSITIVE POWER:
0
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10
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SHARED DISPOSITIVE POWER:
733,333(1)
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON:
733,333(1)
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12
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CHECK IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS): ☒
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13
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11):
2.2%(2)
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14
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS):
OO
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(1)
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Andera is the manager of BioDiscovery 5 and may be deemed to have voting, investment and dispositive power with respect to these securities. Wisniewski is a director of the issuer and is a partner of Andera, and
may be deemed to share voting and dispositive power over the shares held by BioDiscovery 5.
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(2)
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Based on 33,978,911 shares of Common Stock outstanding as of December 12, 2019, based on the information reported by the Issuer in its Form 8-K filed with the Commission on December 12, 2019.
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CUSIP No. 05465P101
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SCHEDULE 13D
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1
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NAMES OF REPORTING PERSON:
Raphaël Wisniewski
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS):
(a) ☐ (b) ☒
|
||||||||||
3
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SEC USE ONLY:
|
||||||||||
4
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SOURCE OF FUNDS (SEE INSTRUCTIONS):
OO
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||||||||||
5
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CHECK IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) OR 2(e): ☐
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||||||||||
6
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CITIZENSHIP OR PLACE OF ORGANIZATION:
France
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||||||||||
NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
|
|
7
|
|
SOLE VOTING POWER:
0
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||||||||
|
8
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SHARED VOTING POWER:
2,957,461(1)
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9
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SOLE DISPOSITIVE POWER:
0
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|||||||||
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10
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SHARED DISPOSITIVE POWER:
2,957,461(1)
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON:
2,957,461(1)
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||||||||||
12
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CHECK IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS): ☐
|
||||||||||
13
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11):
8.7%(2)
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||||||||||
14
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS):
IN
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(1)
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2,224,128 shares are held of record by FCPR and 733,333 shares are held of record by BioDiscovery 5. Andera is the manager of FCPR and BioDiscovery 5, and may be deemed to have voting, investment and dispositive
power with respect to these securities. Wisniewski is a director of the Issuer and is a partner of Andera, and may be deemed to share voting and dispositive power over the shares held
by FCPR and BioDiscovery 5.
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(2)
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Based on 33,978,911 shares of Common Stock outstanding as of December 12, 2019, based on the information reported by the Issuer in its Form 8-K filed with the Commission on December 12, 2019.
|
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|
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CUSIP No. 05465P101
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SCHEDULE 13D
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CUSIP No. 05465P101
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SCHEDULE 13D
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Dated: January 24, 2020
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By:
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ANDERA PARTNERS
/s/ Raphaël Wisniewski
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Name:
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Raphaël Wisniewski
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Title:
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Partner
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By:
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BIODISCOVERY 4 FCPR
By: Andera Partners
Its: Manager
/s/ Raphaël Wisniewski
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Name:
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Raphaël Wisniewski
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Title:
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Partner
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By:
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BIODISCOVERY 5
By: Andera Partners
Its: Manager
/s/ Raphaël Wisniewski
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Name:
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Raphaël Wisniewski
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Title:
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Partner
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By: |
/s/ Raphaël Wisniewski
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Raphaël Wisniewski
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