0001209191-23-035428.txt : 20230608 0001209191-23-035428.hdr.sgml : 20230608 20230608163205 ACCESSION NUMBER: 0001209191-23-035428 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: COOK JEREMY CURNOCK CENTRAL INDEX KEY: 0001216486 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39059 FILM NUMBER: 231002386 MAIL ADDRESS: STREET 1: TARGETED GENETICS CORP STREET 2: 1100 OLIVE WAY STE 100 CITY: SEATTLE STATE: WA ZIP: 98101 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 0001216486 COOK JEREMY CURNOCK C/O AVITA MEDICAL, INC. 28159 AVENUE STANFORD, SUITE 200 VALENCIA CA 91355 1 0 0 0 0 Common Stock 2023-06-06 4 A 0 6175 A 23114 D 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. These Stock Options vest on the date 12 months following the grant date. /s/ Donna Shiroma, by power of attorney 2023-06-08