0001209191-21-071257.txt : 20211227
0001209191-21-071257.hdr.sgml : 20211227
20211227163110
ACCESSION NUMBER: 0001209191-21-071257
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211222
FILED AS OF DATE: 20211227
DATE AS OF CHANGE: 20211227
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: 211520944
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
2021-12-22
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
2021-12-22
4
A
0
4350
A
8462
D
Stock Options (Right to Buy)
12.18
2021-12-22
4
A
0
2550
0.00
A
2031-12-22
Common Stock
2550
2550
D
Represents an award of Restricted Stock Units ("RSUs"), each representing a contingent right to be issued one share of Common Stock, that are subject to time-based vesting criteria. These RSUs vest on the date 12 months following the grant date.
Includes 20,560 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's 20,560 CDIs translate into 4,112 of the shares of Common Stock set forth above.
Includes unvested RSUs.
These Stock Options vest on the date 12 months following the grant date.
/s/ Donna Shiroma, by power of attorney
2021-12-27