SEC FORM 4

SEC Form 4

FORM 4

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

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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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^*

Stockman Robert Bernard

(Last)

(First)

(Middle)

5751 COPLEY DRIVE, SUITE B

(Street)

SAN DIEGO

92111

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
REVA Medical, Inc. [ RVA ]

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

X	Director	10% Owner
X	Officer (give title below)	Other (specify below)
	Chairman and CEO

3. Date of Earliest Transaction (Month/Day/Year)
12/16/2010

4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction 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)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock	12/16/2010		C		47,648⁽¹⁾	A	⁽²⁾	47,648	D
Common Stock	12/16/2010		X		7,685⁽³⁾	A	$6.5066	55,333	D
Common Stock	12/16/2010		X		7,936⁽⁴⁾	A	$6.5066	63,269	D
Common Stock	12/16/2010		X		15,244⁽⁵⁾	A	$3.28	78,513	D
Common Stock	12/16/2010		C		212,402⁽⁶⁾	A	⁽²⁾	212,402	I	By wife
Common Stock	12/16/2010		X		12,764⁽⁷⁾	A	$6.5066	225,166	I	By wife
Common Stock	12/16/2010		X		2,552⁽⁷⁾	A	$6.5066	227,718	I	By wife
Common Stock	12/16/2010		C		176,850	A	⁽²⁾	735,750	I	Group Outcome Investors I, LLC⁽⁸⁾
Common Stock	12/16/2010		C		109,375	A	⁽²⁾	845,125	I	Group Outcome Investors I, LLC⁽⁸⁾
Common Stock	12/16/2010		C		66,624	A	⁽²⁾	911,749	I	Group Outcome Investors I, LLC⁽⁸⁾
Common Stock	12/16/2010		C		204,918	A	⁽²⁾	1,116,667	I	Group Outcome Investors I, LLC⁽⁸⁾
Common Stock	12/16/2010		C		112,755⁽⁹⁾	A	$3.28	1,229,422	I	Group Outcome Investors I, LLC⁽⁸⁾
Common Stock	12/16/2010		C		111,753⁽⁹⁾	A	$3.28	1,341,175	I	Group Outcome Investors I, LLC⁽⁸⁾
Common Stock	12/16/2010		C		3,930	A	⁽²⁾	67,359	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Common Stock	12/16/2010		C		421,875	A	⁽²⁾	489,225	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Common Stock	12/16/2010		C		256,981	A	⁽²⁾	746,206	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Common Stock	12/16/2010		C		204,918	A	⁽²⁾	951,124	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Common Stock	12/16/2010		C		28,591⁽¹¹⁾	A	⁽²⁾	979,715	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Common Stock	12/16/2010		C		112,754⁽⁹⁾	A	$3.28	1,092,469	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Common Stock	12/16/2010		X		5,340⁽¹²⁾	A	$3.28	1,097,809	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Common Stock	12/16/2010		X		1,872⁽¹³⁾	A	$6.5066	1,099,681	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Common Stock	12/16/2010		X		1,934⁽¹⁴⁾	A	$6.5066	1,101,615	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction 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 (Month/Day/Year)		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: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Series H Preferred Stock	⁽²⁾	12/16/2010		C			39,680	⁽²⁾	⁽²⁾	Common Stock	39,680	⁽²⁾	0	D
Warrant	$6.5066	12/16/2010		X			7,685	05/23/2007	05/23/2011	Series H Preferred Stock	7,685	$6.5066	0	D
Warrant	$6.5066	12/16/2010		X			7,936	12/07/2007	12/07/2012	Common Stock	7,936	$6.5066	0	D
CHESS Depository Interests⁽¹⁵⁾	⁽¹⁵⁾	12/16/2010		P		200,000⁽¹⁶⁾		⁽¹⁷⁾	⁽¹⁷⁾	Common Stock	20,000	⁽¹⁸⁾	200,000	D
Series H Preferred Stock	⁽²⁾	12/16/2010		C			188,619	⁽²⁾	⁽²⁾	Common Stock	188,619	⁽²⁾	0	I	By wife
Series A Preferred Stock	⁽²⁾	12/16/2010		C			176,850	⁽²⁾	⁽²⁾	Common Stock	176,850	⁽²⁾	0	I	Group Outcome Investors I, LLC⁽⁸⁾
Series B Preferred Stock	⁽²⁾	12/16/2010		C			109,375	⁽²⁾	⁽²⁾	Common Stock	109,375	⁽²⁾	0	I	Group Outcome Investors I, LLC⁽⁸⁾
Series C Preferred Stock	⁽²⁾	12/16/2010		C			66,624	⁽²⁾	⁽²⁾	Common Stock	66,624	⁽²⁾	0	I	Group Outcome Investors I, LLC⁽⁸⁾
Series D Preferred Stock	⁽²⁾	12/16/2010		C			204,918	⁽²⁾	⁽²⁾	Common Stock	204,918	⁽²⁾	0	I	Group Outcome Investors I, LLC⁽⁸⁾
Convertible Note	$3.28	12/16/2010		C			112,318	11/12/2003	12/31/2011	Series F Preferred Stock	112,318	$3.28	0	I	Group Outcome Investors I, LLC⁽⁸⁾
Convertible Note	$3.28	12/16/2010		C			111,316	01/22/2004	12/31/2011	Series F Preferred Stock	111,316	$3.28	0	I	Group Outcome Investors I, LLC⁽⁸⁾
Warrant	$3.28	12/16/2010		X			15,244	10/22/2004	10/22/2014	Series F Preferred Stock	15,244	$3.28	0	I	Group Outcome Investors I, LLC⁽⁸⁾
Warrant	$6.5055	12/16/2010		X			31,437	05/25/2010	12/07/2012	Common Stock	31,437	$6.5066	0	I	Group Outcome Investors I, LLC⁽⁸⁾
Warrant	$6.5066	12/16/2010		X			6,287	06/02/2010	12/07/2012	Common Stock	6,287	$6.5066	0	I	Group Outcome Investors I, LLC⁽⁸⁾
Series A Preferred Stock	⁽²⁾	12/16/2010		C			3,930	⁽²⁾	⁽²⁾	Common Stock	3,930	⁽²⁾	0	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Series B Preferred Stock	⁽²⁾	12/16/2010		C			421,875	⁽²⁾	⁽²⁾	Common Stock	421,875	⁽²⁾	0	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Series C Preferred Stock	⁽²⁾	12/16/2010		C			256,981	⁽²⁾	⁽²⁾	Common Stock	256,981	⁽²⁾	0	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Series D Preferred Stock	⁽²⁾	12/16/2010		C			204,918	⁽²⁾	⁽²⁾	Common Stock	204,918	⁽²⁾	0	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Series H Preferred Stock	⁽²⁾	12/16/2010		C			23,810	⁽²⁾	⁽²⁾	Common Stock	23,810	⁽²⁾	0	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Convertible Note	$3.28	12/16/2010		C			112,318	11/12/2003	12/31/2011	Series F Preferred Stock	112,318	$3.28	0	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Warrant	$3.28	12/16/2010		X			7,622	10/22/2004	10/22/2014	Series F Preferred Stock	7,622	$3.28	0	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Warrant	$6.5066	12/16/2010		X			4,611	05/23/2007	05/23/2012	Series H Preferred Stock	4,611	$6.5066	0	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
Warrant	$6.5066	12/16/2010		X			4,762	12/07/2007	12/07/2012	Common Stock	4,762	$6.5066	0	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾
CHESS Depository Interests⁽¹⁵⁾	⁽¹⁵⁾	12/16/2010		P		2,454,545⁽¹⁹⁾		⁽¹⁷⁾	⁽¹⁷⁾	Common Stock	245,454	⁽¹⁸⁾	2,454,545	I	Kenneth Rainin Adminsitrative Trust U/D/T 3/29/90⁽¹⁰⁾

Explanation of Responses:

1. Includes 7,968 shares of Series H Preferred Stock which were accrued as cumulative dividends and paid upon the closing of the Issuer's initial public offering on as-converted basis.

2. Each outstanding share of the Issuer's Preferred Stock automatically converted to one share of Common Stock upon the closing of the Issuer's initial public offering.

3. Represents the issuance of Series H Preferred Stock upon the exercise of such warrant upon the closing of the Issuer's initial public offering. Each share of Issuer's Series H Preferred Stock converted to one share Common Stock upon the closing of the Issuer's initial public offering.

4. Represents the issuance of Common Stock upon the exercise of such warrant upon the closing of the Issuer's initial public offering.

5. Represents the issuance of Series F Preferred Stock upon the exercise of such warrant upon the closing of the Issuer's initial public offering. Each share of Issuer's Series F Preferred Stock converted to one share Common Stock upon the closing of the Issuer's initial public offering. The warrant was previously reported as indirectly held by Group Outcome Investors I, LLC. The shares underlying the warrant were issued to Robert Stockman upon exercise of the warrant.

6. Includes 23,783 shares of Series H Preferred Stock which were accrued as cumulative dividends and paid upon the closing of the Issuer's initial public offering on as-converted basis.

7. Represents the issuance of common stock upon the exercise of such warrant on a cashless basis upon the closing of the Issuer's initial public offering. The warrant was previously reported as indirectly held by Group Outcome Investors I, LLC. The shares underlying the warrant were issued to Lisa Stockman, Robert Stockman's wife upon exercise of the warrant.

8. Represents securities held by Group Outcome Investors I, LLC. The members of Group Outcome Investors I, LLC are Isabel Stockman Trust, Martha Davis, Trustee; Hope Stockman Trust, Martha Davis, Trustee; Phoebe Stockman Trust, Martha Davis, Trustee; and Elizabeth Stockman Trust, Martha Davis, Trustee. Each of the members shares voting and dispositive power with respect to the shares. Two of the trustees, Isabel Stockman and Elizabeth Stockman, are dependents of Robert Stockman, our Chairman of the Board and Chief Executive Officer, and for Section 16 purposes, we have reported the full beneficial ownership of Group Outcome Investors I, LLC under Mr. Stockman's beneficial ownership. Mr. Stockman disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein.

9. Represents the conversion of convertible notes into shares of Series F Preferred Stock upon the closing of the Issuer's initial public offering. Includes conversion of additional accrued interest following the date of the Reporting Person's previously filed Form 3 report. Each share of Issuer's Series F Preferred Stock converted to one share common stock upon the closing of the Issuer's initial public offering.

10. Mr. Stockman, along with Jennifer Rainin, is the trustee of the Kenneth Rainin Administrative Trust U/D/T 3/29/90 and has voting and dispositive power with respect to these shares. Mr. Stockman disclaims beneficial ownership except to the extent of his pecuniary interest therein.

11. Includes 4,781 shares of Series H Preferred Stock which were accrued as cumulative dividends and paid upon the closing of the Issuer's initial public offering on as-converted basis.

12. Represents the issuance of Series F Preferred Stock upon the exercise of such warrant on a cashless basis upon the closing of the Issuer's initial public offering. Each share of Issuer's Series F Preferred Stock converted to one share Common Stock upon the closing of the Issuer's initial public offering.

13. Represents the issuance of Series H Preferred Stock upon the exercise of such warrant on a cashless basis upon the closing of the Issuer's initial public offering. Each share of Issuer's Series H preferred stock converted to one share Common Stock upon the closing of the Issuer's initial public offering.

14. Represents the issuance of Common Stock upon the exercise of such warrant on a cashless basis upon the closing of the Issuer's initial public offering.

15. Australian CHESS Depositary Interests (CDIs) trade on the Australian Stock Exchange (ASX) and evidence beneficial ownership of Issuer's Common Stock on a ten-for-one basis.

16. Represents 20,000 shares of Issuer's Common Stock.

17. The CDIs are convertible into the Issuer's Common Stock on a ten-for-one basis at any time.

18. The CDIs were purchased in the Company's initial public offering at a purchase price of A$1.10 per CDI, or the equivelant of A$11.00 per share of Common Stock.

19. Represents 245,454 shares of Issuer's Common Stock.

Remarks:

	/s/ Katrina Thompson, Attorney-in-fact	12/20/2010
	** 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).
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