0001209191-21-031924.txt : 20210511
0001209191-21-031924.hdr.sgml : 20210511
20210511215244
ACCESSION NUMBER: 0001209191-21-031924
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210511
FILED AS OF DATE: 20210511
DATE AS OF CHANGE: 20210511
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Holder Michael
CENTRAL INDEX KEY: 0001515140
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39059
FILM NUMBER: 21913268
MAIL ADDRESS:
STREET 1: 6170 RESEARCH RD., STE 103
CITY: FRISCO
STATE: TX
ZIP: 75034
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: 0630
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
2021-05-11
0
0001762303
AVITA Medical, Inc.
RCEL
0001515140
Holder Michael
C/O AVITA MEDICAL, INC.
28159 AVENUE STANFORD, SUITE 220
VALENCIA
CA
91355
0
1
0
0
Chief Financial Officer
Stock Options (Right to Buy)
19.91
2021-05-11
4
A
0
112500
0.00
A
2031-05-11
Common Stock
112500
112500
D
These Stock Options vest based on performance-based vesting criteria.
/s/ Donna Shiroma, by power of attorney
2021-05-11