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