0001209191-23-004661.txt : 20230124 0001209191-23-004661.hdr.sgml : 20230124 20230124175052 ACCESSION NUMBER: 0001209191-23-004661 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230119 FILED AS OF DATE: 20230124 DATE AS OF CHANGE: 20230124 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: 23549221 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 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2023-01-19 0 0001762303 AVITA Medical, Inc. RCEL 0001833454 Ekins Sean C/O AVITA MEDICAL, INC. 28159 AVENUE STANFORD, SUITE 220 VALENCIA CA 91355 0 1 0 0 Interim CFO Common Stock 14927 D 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 Stock Options (Right to Buy) 21.93 2031-03-17 Common Stock 30000 D Stock Options (Right to Buy) 20.21 2031-07-06 Common Stock 2300 D Stock Options (Right to Buy) 18.21 2031-08-26 Common Stock 1650 D Stock Options (Right to Buy) 4.97 2032-07-01 Common Stock 7050 D Includes unvested Restricted Stock Units, each representing a contingent right to be issued one share of Common Stock. 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. These Stock Options became exercisable upon the satisfaction of time-based and 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). These Stock Options become exercisable in four equal annual installments beginning on March 17, 2022. These Stock Options become exercisable in four equal annual installments beginning on July 6, 2022. These Stock Options become exercisable in four equal annual installments beginning on August 26, 2022. These Stock Options become exercisable in three equal annual installments beginning on August 20, 2023. /s/ Donna Shiroma, by power of attorney 2023-01-24