0001209191-21-057037.txt : 20210921
0001209191-21-057037.hdr.sgml : 20210921
20210921163030
ACCESSION NUMBER: 0001209191-21-057037
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210920
FILED AS OF DATE: 20210921
DATE AS OF CHANGE: 20210921
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Crowe Suzanne
CENTRAL INDEX KEY: 0001816242
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39059
FILM NUMBER: 211266820
MAIL ADDRESS:
STREET 1: C/O AVITA MEDICAL
STREET 2: 28159 AVENUE STANFORD, SUITE 220
CITY: VALENCIA
STATE: CA
ZIP: 91355
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
2021-09-20
0
0001762303
AVITA Medical, Inc.
RCEL
0001816242
Crowe Suzanne
C/O AVITA THERAPEUTICS, INC.
28159 AVENUE STANFORD, SUITE 220
VALENCIA
CA
91355
1
0
0
0
Common Stock
2021-09-20
4
P
0
1066
17.08
A
4112
D
Reflects 5,330 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 the Issuer's common stock and have all the rights and privileges of common stock.
The purchase price was converted from A$4.72, using the exchange rate as in effect on the date of the transaction, and reflects the 5:1 consolidation ratio applied in converting CDIs to shares of the Issuer's common stock.
The Reporting Person holds 20,560 CDIs, which translate into the 4,112 shares of common stock set forth above.
/s/ Donna Shiroma, by power of attorney
2021-09-21