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