Statement of Changes in Beneficial Ownership (4)
03 June 2022 - 07:02AM
Edgar (US Regulatory)
FORM 4
[ ] Check this box if no longer subject to Section
16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
|
OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
|
Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
|
|
1. Name
and Address of Reporting Person * PERRY MICHAEL S |
2. Issuer Name and Ticker or Trading
Symbol AVITA Medical, Inc. [ RCEL ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Chief Executive Officer |
(Last)
(First)
(Middle)
C/O AVITA MEDICAL, INC., 28159 AVENUE STANFORD, SUITE
220 |
3. Date of Earliest Transaction (MM/DD/YYYY)
6/1/2022
|
(Street)
VALENCIA, CA 91355
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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 Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
6/1/2022 |
|
J(1) |
V |
23754 |
D |
$0.00 |
297958 (2)(3) |
D |
|
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. Code
(Instr. 8) |
5. Number of Derivative Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date |
7. Title and Amount of Securities Underlying
Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of derivative Securities Beneficially
Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of
Responses: |
(1) |
These shares of Common Stock
represent half of the shares of Common Stock that were issued upon
the vesting of Restricted Stock Units ("RSUs") that were previously
included in the amount of shares of Common Stock beneficially owned
by the Reporting Person. Upon vesting of the RSUs, these shares of
Common Stock were transferred to the Reporting Person's former
spouse pursuant to a property settlement agreement. |
(2) |
Includes 71,440 unvested
RSUs with vesting conditions based on the Reporting Person's
continued employment or the market price of the Issuer's common
stock. Pursuant to a property settlement agreement, half of the
shares of Common Stock underlying such RSUs will be transferred to
the Reporting Person's former spouse upon the respective vesting
events. |
(3) |
Includes 634,602 of the
Issuer's CHESS Depositary Interests ("CDIs"). 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. The Reporting Person holds
634,602 CDIs, which translate into 126,920 of the shares of Common
Stock set forth above. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
PERRY MICHAEL S
C/O AVITA MEDICAL, INC.
28159 AVENUE STANFORD, SUITE 220
VALENCIA, CA 91355 |
X |
|
Chief Executive Officer |
|
Signatures
|
/s/ Donna Shiroma, by power of
attorney |
|
6/2/2022 |
**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 4(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). |
Note: |
File three copies of this Form, one of
which must be manually signed. If space is insufficient, see
Instruction 6 for procedure. |
Persons who respond to the collection of information
contained in this form are not required to respond unless the form
displays a currently valid OMB control number. |
Avita Medical (NASDAQ:RCEL)
Historical Stock Chart
From Jul 2022 to Aug 2022
Avita Medical (NASDAQ:RCEL)
Historical Stock Chart
From Aug 2021 to Aug 2022