Donna Shiroma Form 3 Avita Therapeutics / Donna Shiroma ownership change

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^*

Shiroma Donna

(Last) (First) (Middle)

C/O AVITA THERAPEUTICS, INC.

28159 AVENUE STANFORD, SUITE 220

(Street)

VALENCIA CA 91355

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
06/30/2020

3. Issuer Name and Ticker or Trading Symbol
Avita Therapeutics, Inc. [ RCEL ]

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

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
General Counsel

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)

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)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Stock Options (Right to Buy)(1)	(2)	06/25/2028	Common Stock	4,000	4.38(3)	D
Stock Options (Right to Buy)(1)	(4)	11/01/2028	Common Stock	26,100	6.35(5)	D
Stock Options (Right to Buy)(1)	(6)	11/30/2028	Common Stock	64,700	5.99(7)	D
Stock Options (Right to Buy)(1)	(8)	06/25/2028	Common Stock	4,200	4.38(3)	D

Explanation of Responses:

1. These Stock Options were originally exercisable for ordinary shares of Avita Medical, Ltd. ("Predecessor"). Pursuant to the 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.

2. These Stock Options become exercisable in four equal annual installments beginning on June 25, 2019.

3. The exercise price was converted from A$5.9, 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 25, 2018). The actual exercise price will be the Australian dollar amount regardless of the exchange rate on the date of grant or of exercise.

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

5. The exercise price was converted from A$8.9, 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). The actual exercise price will be the Australian dollar amount regardless of the exchange rate on the date of grant or of exercise.

6. These Stock Options become exercisable in four equal annual installments beginning on November 30, 2019.

7. The exercise price was converted from A$8.2, 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 30, 2018). The actual exercise price will be the Australian dollar amount regardless of the exchange rate on the date of grant or of exercise.

8. These Stock Options became exercisable based on performance-based vesting criteria.

Remarks:

	/s/ Donna Shiroma	07/10/2020
	** 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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