0001209191-23-035432.txt : 20230608
0001209191-23-035432.hdr.sgml : 20230608
20230608163339
ACCESSION NUMBER: 0001209191-23-035432
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: CORBETT JAMES
CENTRAL INDEX KEY: 0001238620
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39059
FILM NUMBER: 231002419
MAIL ADDRESS:
STREET 1: 2 GOODYEAR
CITY: IRVINE
STATE: CA
ZIP: 92618
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
0001238620
CORBETT JAMES
C/O AVITA MEDICAL, INC.
28159 AVENUE STANFORD, SUITE 200
VALENCIA
CA
91355
1
1
0
0
CEO
0
Stock Options (Right to Buy)
14.17
2023-06-06
4
A
0
100000
0.00
A
2033-06-06
Common Stock
100000
100000
D
The reporting person may elect to acquire the Issuer's CHESS Depositary Interests ("CDIs") in place of common stock upon 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.
These Stock Options vest in three equal annual installments beginning on the date 12 months following the grant date.
/s/ Donna Shiroma, by power of attorney
2023-06-08