Investor Relations: SEC Filing | AVITA Medical, Inc.

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SEC FORM 3 SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Ekins Sean

(Last)

(First)

(Middle)

C/O AVITA MEDICAL, INC.

28159 AVENUE STANFORD, SUITE 220

(Street)

VALENCIA

91355

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
01/19/2023

3. Issuer Name and Ticker or Trading Symbol
AVITA Medical, Inc. [ RCEL ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
Interim CFO

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	14,927⁽¹⁾	D

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Stock Options (Right to Buy)⁽²⁾	⁽³⁾	06/12/2028	Common Stock	9,000	4.26⁽⁴⁾	D
Stock Options (Right to Buy)⁽²⁾	⁽⁵⁾	06/12/2028	Common Stock	5,000	4.26⁽⁴⁾	D
Stock Options (Right to Buy)⁽²⁾	⁽⁶⁾	11/01/2028	Common Stock	5,000	6.38⁽⁷⁾	D
Stock Options (Right to Buy)⁽²⁾	⁽⁸⁾	10/01/2029	Common Stock	5,000	39.58⁽⁹⁾	D
Stock Options (Right to Buy)	⁽¹⁰⁾	03/17/2031	Common Stock	30,000	21.93	D
Stock Options (Right to Buy)	⁽¹¹⁾	07/06/2031	Common Stock	2,300	20.21	D
Stock Options (Right to Buy)	⁽¹²⁾	08/26/2031	Common Stock	1,650	18.21	D
Stock Options (Right to Buy)	⁽¹³⁾	07/01/2032	Common Stock	7,050	4.97	D

Explanation of Responses:

1. Includes unvested Restricted Stock Units, each representing a contingent right to be issued one share of Common Stock.

2. 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.

3. These Stock Options became exercisable upon the satisfaction of time-based and performance-based vesting criteria.

4. 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).

5. These Stock Options become exercisable in four equal annual installments beginning on June 12, 2019.

6. These Stock Options become exercisable in four equal annual installments beginning on November 1, 2019.

7. 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).

8. These Stock Options become exercisable in four equal annual installments beginning on October 1, 2020.

9. 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).

10. These Stock Options become exercisable in four equal annual installments beginning on March 17, 2022.

11. These Stock Options become exercisable in four equal annual installments beginning on July 6, 2022.

12. These Stock Options become exercisable in four equal annual installments beginning on August 26, 2022.

13. These Stock Options become exercisable in three equal annual installments beginning on August 20, 2023.

Remarks:

	/s/ Donna Shiroma, by power of attorney	01/24/2023
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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