# EDGAR Filing Document

**Accession Number:** 0001603756
**File Stem:** 0001562180-23-000875
**Filing Date:** 2023-2
**Character Count:** 11052
**Document Hash:** 0b6eef5c8d6f4ad4a2b9b0a8833a187c
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001562180-23-000875.hdr.sgml**: 20230202

**ACCESSION NUMBER**: 0001562180-23-000875

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230131

**FILED AS OF DATE**: 20230202

**DATE AS OF CHANGE**: 20230202

**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:** 23583264

**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>2023-01-31 | **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 | 2023-01-31 |  | A |  | 7500.00 | A | $0.00 | 44273.00 | D |  |
| Common Stock | 2023-01-31 |  | M |  | 16500.00 | A | $0.00 | 60773.00 | D |  |
| Common Stock | 2023-01-31 |  | S<sup>(1)</sup> |  | 4235.00 | D | 61.1694<sup>(2)</sup> | 56538.00 | D |  |
| Common Stock | 2023-01-31 |  | S<sup>(1)</sup> |  | 1999.00 | D | 61.1219<sup>(3)</sup> | 54539.00 | D |  |
| Common Stock | 2023-02-01 |  | S<sup>(1)</sup> |  | 541.00 | D | 60.4347<sup>(4)</sup> | 53998.00 | D |  |
| Common Stock | 2023-02-01 |  | S<sup>(1)</sup> |  | 3164.00 | D | 61.016<sup>(5)</sup> | 50834.00 | 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 |
| Performance-Based Restricted Stock Units<sup>(6)</sup> | <sup>(6)</sup> | 2023-01-31 |  | A |  | 15000.00 |  | 2024-01-31 | <sup>(6)</sup> | Common Stock | 15000.00 | $0.00 | 15000.00 | D |  |
| Performance-Based Restricted Stock Units<sup>(7)</sup> | <sup>(7)</sup> | 2023-01-31 |  | A |  | 7500.00 |  | 2025-01-31 | <sup>(7)</sup> | Common Stock | 7500.00 | $0.00 | 7500.00 | D |  |
| Performance-Based Restricted Stock Units<sup>(8)</sup> | <sup>(8)</sup> | 2023-01-31 |  | M |  |  | 5250.00 | 2023-01-31 | <sup>(8)</sup> | Common Stock | 5250.00 | $0.00 | 0.00 | D |  |
| Performance-Based Restricted Stock Units<sup>(9)</sup> | <sup>(9)</sup> | 2023-01-31 |  | M |  |  | 11250.00 | 2023-01-31 | <sup>(9)</sup> | Common Stock | 11250.00 | $0.00 | 0.00 | D |  |

---

### Footnotes:

(1) Shares of Issuer's common stock sold to cover the reporting person's tax obligation in connection with the conversion of the Performance-Based Restricted Stock Units disclosed herein.

(2) This transaction was executed in multiple trades at prices ranging from $60.78 to $61.595. The price reported above reflects the weighted average price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected.

(3) This transaction was executed in multiple trades at prices ranging from $60.78 to $61.60. The price reported above reflects the weighted average price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected.

(4) This transaction was executed in multiple trades at prices ranging from $59.85 to $60.845. The price reported above reflects the weighted average price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected.

(5) This transaction was executed in multiple trades at prices ranging from $60.85 to $61.58. The price reported above reflects the weighted average price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected.

(6) Each 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, 2023 and provided the reporting person remains in continuous service through January 31, 2024.

(7) The 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 January 31, 2025, and provided the reporting person remains in continuous service through January 31, 2025.

(8) Each 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, 2022 and provided the reporting person remains in continuous service through January 31, 2023.

(9) The 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 January 31, 2023, and provided the reporting person remains in continuous service through January 31, 2023.

**Signature:** /s/ Dan Dearen, as Attorney-in-Fact for Alfred J. Ford, Jr.  
**Date:** 2023-02-02

### 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.**