# EDGAR Filing Document

**Accession Number:** 0001762303
**File Stem:** 0001209191-23-004661
**Filing Date:** 2023-1
**Character Count:** 7519
**Document Hash:** fee38177ba9968e6be4eb1179507702e
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001209191-23-004661.hdr.sgml**: 20230124

**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

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

## FORM 3

### INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Ekins Sean<br><sub>(Last) (First) (Middle)</sub><br>C/O AVITA MEDICAL, INC.<br>28159 AVENUE STANFORD, SUITE 220<br><sub>(Street)</sub><br>VALENCIA, CA 91355<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>AVITA Medical, Inc. [ RCEL ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2023-01-19 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director   [ ] 10% Owner<br>[X] Officer (give title below)   [ ] Other (specify below)<br>_Interim CFO_ | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities Beneficially Owned

---

|  |  |  |  |
| --- | --- | --- | --- |
| 1. Title of Security | 2. Amount of Securities Beneficially Owned | 3. Ownership Form | 4. Nature of Indirect Beneficial Ownership |
| Common Stock | 14927<sup>(1)</sup> | D |  |

---

## Table II - Derivative Securities Beneficially Owned

---

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Underlying Securities | 3. Title and Amount of Underlying Securities | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| Stock Options (Right to Buy)<sup>(2)</sup> | <sup>(3)</sup> | 2028-06-12 | Common Stock | 9000 | 4.26<sup>(4)</sup> | D |  |
| Stock Options (Right to Buy)<sup>(2)</sup> | <sup>(5)</sup> | 2028-06-12 | Common Stock | 5000 | 4.26<sup>(4)</sup> | D |  |
| Stock Options (Right to Buy)<sup>(2)</sup> | <sup>(6)</sup> | 2028-11-01 | Common Stock | 5000 | 6.38<sup>(7)</sup> | D |  |
| Stock Options (Right to Buy)<sup>(2)</sup> | <sup>(8)</sup> | 2029-10-01 | Common Stock | 5000 | 39.58<sup>(9)</sup> | D |  |
| Stock Options (Right to Buy) | <sup>(10)</sup> | 2031-03-17 | Common Stock | 30000 | $21.93 | D |  |
| Stock Options (Right to Buy) | <sup>(11)</sup> | 2031-07-06 | Common Stock | 2300 | $20.21 | D |  |
| Stock Options (Right to Buy) | <sup>(12)</sup> | 2031-08-26 | Common Stock | 1650 | $18.21 | D |  |
| Stock Options (Right to Buy) | <sup>(13)</sup> | 2032-07-01 | Common Stock | 7050 | $4.97 | D |  |

---

### Footnotes:

(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.

**Signature:** /s/ Donna Shiroma, by power of attorney  
**Date:** 2023-01-24

### Remarks:

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 Number.**