# EDGAR Filing Document

**Accession Number:** 0001359446
**File Stem:** 0001562180-23-000494
**Filing Date:** 2023-1
**Character Count:** 9061
**Document Hash:** f285e6952f7af64ef72e9557e10c544b
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001562180-23-000494.hdr.sgml**: 20230118

**ACCESSION NUMBER**: 0001562180-23-000494

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230113

**FILED AS OF DATE**: 20230118

**DATE AS OF CHANGE**: 20230118

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Ford Alfred J Jr
- **CENTRAL INDEX KEY:** 0001359446

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-38721
- **FILM NUMBER:** 23535680

**MAIL ADDRESS:**
- **STREET 1:** 3303 MONTE VILLA PARKWAY
- **CITY:** BOTHELL
- **STATE:** WA
- **ZIP:** 98021
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Axonics, Inc.
- **CENTRAL INDEX KEY:** 0001603756
- **STANDARD INDUSTRIAL CLASSIFICATION:** SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
- **IRS NUMBER:** 454744083
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 26 TECHNOLOGY DRIVE
- **CITY:** IRVINE
- **STATE:** CA
- **ZIP:** 92618
- **BUSINESS PHONE:** 949-396-6322

**MAIL ADDRESS:**
- **STREET 1:** 26 TECHNOLOGY DRIVE
- **CITY:** IRVINE
- **STATE:** CA
- **ZIP:** 92618

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** Axonics Modulation Technologies, Inc.
- **DATE OF NAME CHANGE:** 20140326

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Ford Alfred J Jr<br><sub>(Last) (First) (Middle)</sub><br>26 TECHNOLOGY DRIVE<br><sub>(Street)</sub><br>IRVINE, CA 92618<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-01-13 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_Chief Commercial Officer_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Axonics, Inc. [ AXNX ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2023-01-13 |  | M |  | 8509.00 | A | $1.42 | 45282.00 | D |  |
| Common Stock | 2023-01-13 |  | M |  | 1899.00 | A | $1.63 | 47181.00 | D |  |
| Common Stock | 2023-01-13 |  | M |  | 9310.00 | A | $25.82 | 56491.00 | D |  |
| Common Stock | 2023-01-13 |  | M |  | 16297.00 | A | $14.19 | 72788.00 | D |  |
| Common Stock | 2023-01-13 |  | S |  | 15292.00 | D | 65.8972<sup>(1)</sup> | 57496.00 | D |  |
| Common Stock | 2023-01-13 |  | S |  | 17108.00 | D | 66.6866<sup>(2)</sup> | 40388.00 | D |  |
| Common Stock | 2023-01-13 |  | S |  | 3615.00 | D | 67.1759<sup>(3)</sup> | 36773.00 | D |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Stock Option (Right to Buy) | $25.82 | 2023-01-13 |  | M |  |  | 9310.00 | <sup>(4)</sup> | 2029-12-12 | Common Stock | 9310.00 | $0.00 | 4655.00 | D |  |
| Stock Option (Right to Buy) | $14.19 | 2023-01-13 |  | M |  |  | 16297.00 | <sup>(5)</sup> | 2029-01-30 | Common Stock | 16297.00 | $0.00 | 0.00 | D |  |
| Stock Option (Right to Buy) | $1.63 | 2023-01-13 |  | M |  |  | 1899.00 | <sup>(6)</sup> | 2028-03-30 | Common Stock | 1899.00 | $0.00 | 0.00 | D |  |
| Stock Option (Right to Buy) | $1.42 | 2023-01-13 |  | M |  |  | 8509.00 | <sup>(7)</sup> | 2027-11-15 | Common Stock | 8509.00 | $0.00 | 0.00 | D |  |

---

### Footnotes:

(1) This transaction was executed in multiple trades at prices ranging from $65.05 USD to $66.04 USD; the price reported above reflects the weighted average sale price.

(2) This transaction was executed in multiple trades at prices ranging from $66.085 USD to $67.08 USD; the price reported above reflects the weighted average sale price.

(3) This transaction was executed in multiple trades at prices ranging from $67.13 USD to $67.215 USD; the price reported above reflects the weighted average sale price.

(4) The option becomes exercisable as follows: (i) 1/4 of the total number of shares of common stock underlying the option will vest on December 12, 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 December 12, 2023, provided the reporting person remains in continuous service on each vesting date.

(5) The 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.

(6) The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on March 30, 2018 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of March 30, 2018, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable.

(7) The shares subject to the option will vest over a period of four years, with 1/4th of the shares subject to the option vesting on November 15, 2017 and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of November 15, 2017, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. The option is subject to an early exercise provision and is immediately exercisable.

**Signature:** /s/ Dan Dearen, as Attorney-in-Fact for Alfred J. Ford, Jr.  
**Date:** 2023-01-18

### Remarks:

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**