0001209191-20-059968.txt : 20201123 0001209191-20-059968.hdr.sgml : 20201123 20201123162535 ACCESSION NUMBER: 0001209191-20-059968 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20201109 FILED AS OF DATE: 20201123 DATE AS OF CHANGE: 20201123 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ekins Sean CENTRAL INDEX KEY: 0001833454 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39059 FILM NUMBER: 201337756 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 Therapeutics, 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: 661-367-9170 MAIL ADDRESS: STREET 1: 28159 AVENUE STANFORD STREET 2: SUITE 220 CITY: VALENCIA STATE: CA ZIP: 91355 FORMER COMPANY: FORMER CONFORMED NAME: Avita Medical, Ltd. DATE OF NAME CHANGE: 20181218 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2020-11-09 0 0001762303 Avita Therapeutics, Inc. RCEL 0001833454 Ekins Sean C/O AVITA THERAPEUTICS, INC. 28159 AVENUE STANFORD, SUITE 220 VALENCIA CA 91355 0 1 0 0 Sr. VP of Finance Stock Options (Right to Buy) 4.26 2028-06-12 Common Stock 9000 D Stock Options (Right to Buy) 4.26 2028-06-12 Common Stock 5000 D Stock Options (Right to Buy) 6.38 2028-11-01 Common Stock 5000 D Stock Options (Right to Buy) 39.58 2029-10-01 Common Stock 5000 D These Stock Options were originally exercisable for ordinary shares of Avita Medical, Ltd. ("Predecessor"). Pursuant to a scheme of arrangement, completed on June 30, 2020, the Stock Options became exercisable for shares of Common Stock of the Issuer in the ratio of one share of Common Stock for every 100 ordinary shares of Predecessor for which the Stock Options would otherwise be exercisable. 6,000 of these Stock Options are currently exercisable and 3,000 become exercisable based on performance-based vesting criteria The exercise price was converted from A$0.056, which reflects the 100:1 consolidation ratio applied in converting ordinary shares of Predecessor to shares of the Issuer's Common Stock, using the exchange rate as in effect on the date of grant (June 12, 2018). These Stock Options become exercisable in four equal annual installments beginning on June 12, 2019. These Stock Options become exercisable in four equal annual installments beginning on November 1, 2019. The exercise price was converted from A$0.089, which reflects the 100:1 consolidation ratio applied in converting ordinary shares of Predecessor to shares of the Issuer's Common Stock, using the exchange rate as in effect on the date of grant (November 1, 2018). These Stock Options become exercisable in four equal annual installments beginning on October 1, 2020. The exercise price was converted from A$0.590, which reflects the 100:1 consolidation ratio applied in converting ordinary shares of Predecessor to shares of the Issuer's Common Stock, using the exchange rate as in effect on the date of grant (October 1, 2019). /s/ Donna Shiroma, by power of attorney 2020-11-23 EX-24.3_946658 2 poa.txt POA DOCUMENT POWER OF ATTORNEY (For Executing Form ID and Forms 3, 4 and 5) Know all by these presents, that the undersigned hereby constitutes and appoints Donna Shiroma of AVITA Therapeutics, Inc. (the "Company") and Jonathan Miner and Coleman Wombwell of K&L Gates LLP, signing individually, the undersigned's true and lawful attorneys in fact and agents to: (1) Prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the Securities and Exchange Commission (the "SEC") a Form ID, Uniform Application for Access Codes to File on EDGAR, including amendments thereto, and any other documents necessary or appropriate to obtain codes and passwords enabling the undersigned to make electronic filings with the SEC of reports required by Section 16(a) of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), or any rule or regulation thereunder; (2) Prepare, execute in the undersigned's name and on the undersigned's behalf, and submit to the SEC Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in connection therewith) in accordance with Section 16(a) of the Exchange Act and the rules thereunder in the undersigned's capacity as an officer, director or beneficial owner of more than 10% of a registered class of securities of the Company; (3) Do and perform any and all acts for and on behalf of the undersigned that may be necessary or desirable to prepare and execute any such Form 3, 4 or 5 (including amendments thereto and joint filing agreements in connection therewith) and file such forms with the SEC and any stock exchange, self-regulatory association or any similar authority; and (4) Take any other action of any type whatsoever in connection with the foregoing that, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required of the undersigned, it being understood that the documents executed by the attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as the attorney-in-fact may approve in the attorney-in-fact's discretion. The undersigned hereby grants to such attorney in fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney in fact, or such attorney in fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorney-in-fact, and their substitutes, in serving in such capacity at the request of the undersigned, are not assuming (nor is the Company assuming) any of the undersigned's responsibilities to comply with Section 16 of the Exchange Act. This Power of Attorney shall remain in full force and effect until the earliest to occur of (a) the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, (b) revocation by the undersigned in a signed writing delivered to the Company and the foregoing attorneys in fact or (c) as to any attorney-in-fact individually, until such attorney-in-fact is no longer employed by the Company or K&L Gates LLP, as applicable. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of the date written below. Date: November 18, 2020 By: /s/ Sean Ekins Name: Sean Ekins