0001209191-23-035442.txt : 20230608 0001209191-23-035442.hdr.sgml : 20230608 20230608163850 ACCESSION NUMBER: 0001209191-23-035442 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: Shiroma Donna CENTRAL INDEX KEY: 0001816251 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39059 FILM NUMBER: 231002494 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: 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 0001816251 Shiroma Donna C/O AVITA MEDICAL, INC. 28159 AVENUE STANFORD, SUITE 220 VALENCIA CA 91355 0 1 0 0 General Counsel 0 Stock Options (Right to Buy) 14.17 2023-06-06 4 A 0 60000 0.00 A 2033-06-06 Common Stock 60000 60000 D These Stock Options vest in three equal annual installments beginning on the date 12 months following the grant date. /s/ Donna Shiroma 2023-06-08