Sec Form 4 Filing - Sama Rinda @ Axonics Modulation Technologies, Inc. - 2020-10-29

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Sama Rinda
2. Issuer Name and Ticker or Trading Symbol
Axonics Modulation Technologies, Inc. [ AXNX]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Operating Officer
(Last) (First) (Middle)
26 TECHNOLOGY DRIVE
3. Date of Earliest Transaction (MM/DD/YY)
10/29/2020
(Street)
IRVINE, CA92618
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 10/29/2020 M 7,373 A $ 14.19 127,374 D
Common Stock 10/29/2020 M 2,627 A $ 1.63 130,001 D
Common Stock 10/29/2020 M 2,863 A $ 14.19 132,864 D
Common Stock 10/29/2020 S( 1 ) 6,200 D $ 47.7129 ( 2 ) 126,664 D
Common Stock 10/29/2020 S( 1 ) 3,800 D $ 48.1247 ( 3 ) 122,864 D
Common Stock 10/29/2020 S( 1 ) 2,863 D $ 48.6 120,001 D
Common Stock 10/30/2020 S( 1 ) 6,037 D $ 47.8056 ( 4 ) 113,964 D
Common Stock 10/30/2020 S( 1 ) 1,100 D $ 48.5427 ( 5 ) 112,864 D
Common Stock 11/03/2020 S( 1 ) 300 D $ 50 112,564 D
Common Stock 4,000 I By Spouse
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) $ 14.19 10/29/2020 M 7,373 ( 6 ) 01/30/2029 Common Stock 7,373 $ 0 48,112 D
Stock Option (Right to Buy) $ 14.19 10/29/2020 M 2,863 ( 6 ) 01/30/2029 Common Stock 2,863 $ 0 45,249 D
Stock Option (Right to Buy) $ 1.63 10/29/2020 M 2,627 ( 7 ) 03/30/2028 Common Stock 2,627 $ 0 8,916 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Sama Rinda
26 TECHNOLOGY DRIVE
IRVINE, CA92618
Chief Operating Officer
Signatures
/s/ Dan Dearen, as Attorney-in-Fact for Rinda Sama 11/03/2020
Signature of Reporting Person Date
Explanation of Responses:
( 1 )This sale was pursuant to a 10b5-1 plan adopted by the reporting person on September 22, 2020.
( 2 )This transaction was executed in multiple trades at prices ranging from $47.01 to $48.00. 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 $48.01 to $48.50. 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 $47.35 to $48.28. 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 $48.42 to $48.63. 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 )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 January 30th, 2020, and the remainder vesting at a rate of 1/36th per month commencing upon the one-year anniversary of January 30th, 2020, 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 )25% of the Total Number of Shares shall vest upon the Vesting Commencement Date. The remainder shall vest at a rate of 1/36th per month commencing upon the one-year anniversary of the Vesting Commencement Date beginning on 30-Mar-2018

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