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