0001209191-23-035438.txt : 20230608
0001209191-23-035438.hdr.sgml : 20230608
20230608163701
ACCESSION NUMBER: 0001209191-23-035438
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230606
FILED AS OF DATE: 20230608
DATE AS OF CHANGE: 20230608
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Panaccio Lou
CENTRAL INDEX KEY: 0001816237
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39059
FILM NUMBER: 231002463
MAIL ADDRESS:
STREET 1: C/O AVITA MEDICAL
STREET 2: 28159 AVENUE STANFORD, SUITE 200
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: 1231
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
X0407
4
2023-06-06
0
0001762303
AVITA Medical, Inc.
RCEL
0001816237
Panaccio Lou
C/O AVITA MEDICAL, INC.
28159 AVENUE STANFORD, SUITE 220
VALENCIA
CA
91355
1
0
0
0
0
Common Stock
2023-06-06
4
A
0
6175
A
37206
D
Common Stock
5972
I
See footnote
Stock Options (Right to Buy)
14.17
2023-06-06
4
A
0
2646
0.00
A
2033-06-06
Common Stock
2646
2646
D
The reporting person may elect to acquire the Issuer's CHESS Depositary Interests ("CDIs") in place of common stock upon vesting of a Restricted Stock Unit ("RSU") or exercise of a Stock Option. 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.
Represents an award of 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 unvested RSUs.
Includes 70,460 of the Issuer's CDIs. The Reporting Person holds 70,460 CDIs, which translate into 14,092 of the shares of Common Stock set forth above.
Reflects 29,860 CDIs, which translate into the 5,972 shares of Common Stock set forth above.
These CDIs are held by The Panaccio Superannuation Fund (the "Fund"). The Reporting Person is a director of Tercus Pty Ltd, trustee of the Fund, and is a beneficiary of the Fund. The Reporting Person may be deemed to have shared voting and dispositive power over the CDIs held by the Fund but disclaims such beneficial ownership, except to the extent of his pecuniary interest therein.
These Stock Options vest on the date 12 months following the grant date.
/s/ Donna Shiroma, by power of attorney
2023-06-08