0001209191-22-058404.txt : 20221122
0001209191-22-058404.hdr.sgml : 20221122
20221122164647
ACCESSION NUMBER: 0001209191-22-058404
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20221121
FILED AS OF DATE: 20221122
DATE AS OF CHANGE: 20221122
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: PERRY MICHAEL S
CENTRAL INDEX KEY: 0001250379
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39059
FILM NUMBER: 221411096
MAIL ADDRESS:
STREET 1: C/O BIOTRANSPLANT INC
STREET 2: 196 BOSTON AVE SUITE 2800
CITY: MEDFORD
STATE: MA
ZIP: 02155
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: AVITA Medical, Inc.
CENTRAL INDEX KEY: 0001762303
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 202578762
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 28159 AVENUE STANFORD
STREET 2: SUITE 220
CITY: VALENCIA
STATE: CA
ZIP: 91355
BUSINESS PHONE: 661-568-1317
MAIL ADDRESS:
STREET 1: 28159 AVENUE STANFORD
STREET 2: SUITE 220
CITY: VALENCIA
STATE: CA
ZIP: 91355
FORMER COMPANY:
FORMER CONFORMED NAME: Avita Therapeutics, Inc.
DATE OF NAME CHANGE: 20200630
FORMER COMPANY:
FORMER CONFORMED NAME: Avita Medical, Ltd.
DATE OF NAME CHANGE: 20181218
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2022-11-21
0
0001762303
AVITA Medical, Inc.
RCEL
0001250379
PERRY MICHAEL S
C/O AVITA MEDICAL, INC.
28159 AVENUE STANFORD, SUITE 220
VALENCIA
CA
91355
1
0
0
0
Common Stock
2022-11-21
4
M
0
150000
5.99
A
379543
D
Common Stock
2022-11-21
4
S
0
150000
7.18
D
229543
D
Stock Options (Right to Buy)
5.99
2022-11-21
4
M
0
150000
0.00
D
2020-09-09
2022-11-27
Common Stock
150000
0
D
The exercise price was converted from A$8.20, which reflects the 100:1 consolidation ratio applied in converting ordinary shares of Predecessor (as defined below) to shares of the Issuer's Common Stock, using the exchange rate as published by the Reserve Bank of Australia in effect on the date of grant (November 30, 2018).
Includes 634,602 of the Issuer's CHESS Depositary Interests ("CDIs"). CDIs are units of beneficial ownership in shares of common stock of the Issuer that are publicly traded on the Australian Securities Exchange (the "ASX") and held by CHESS Depositary Nominees Pty, Limited, a subsidiary of ASX Limited, the company that operates the ASX. Five CDIs are equivalent to one share of Common Stock and have all the rights and privileges of Common Stock. The Reporting Person holds 634,602 CDIs, which translate into 126,920 of the shares of Common Stock set forth above.
The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $7.05 to $7.45. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of the shares of Common Stock sold at each separate price within the ranges set forth in this footnote to this Form 4.
These Stock Options were originally exercisable for ordinary shares of of AVITA Medical, Ltd., an Australian public company and predecessor to the Issuer ("Predecessor"). Pursuant to a scheme of arrangement, completed on June 30, 2020, the Stock Options became exercisable for shares of Common Stock of the Issuer in the ratio of one share of Common Stock for every 100 ordinary shares of Predecessor for which the Stock Options would otherwise have been exercisable.
/s/ Donna Shiroma, by power of attorney
2022-11-22