0001209191-15-050210.txt : 20150604
0001209191-15-050210.hdr.sgml : 20150604
20150604175835
ACCESSION NUMBER: 0001209191-15-050210
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150603
FILED AS OF DATE: 20150604
DATE AS OF CHANGE: 20150604
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: REVA Medical, Inc.
CENTRAL INDEX KEY: 0001496268
STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842]
IRS NUMBER: 330810505
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 5751 COPLEY DRIVE
CITY: SAN DIEGO
STATE: CA
ZIP: 92111
BUSINESS PHONE: (858) 966-3000
MAIL ADDRESS:
STREET 1: 5751 COPLEY DRIVE
CITY: SAN DIEGO
STATE: CA
ZIP: 92111
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Stockman Robert Bernard
CENTRAL INDEX KEY: 0001404726
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-54192
FILM NUMBER: 15913952
MAIL ADDRESS:
STREET 1: SUITE 4 LEVEL 46 2 PARK STREET
CITY: SIDNEY
STATE: C3
ZIP: 2000
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-06-03
0
0001496268
REVA Medical, Inc.
RVA:AX
0001404726
Stockman Robert Bernard
5751 COPLEY DRIVE
SAN DIEGO
CA
92111
1
1
0
0
Chairman and CEO
Common Stock
2015-06-03
4
P
0
6250
4.00
A
249313
D
Common Stock
227718
I
By wife
Common Stock
1341175
I
Group Outcome Investors I, LLC
Common Stock
1101615
I
Kenneth Rainin Administrative Trust U/D/T 3/29/90
Represents the purchase of 62,500 of the Company's Chess Depository Interests (CDIs), trading on the Austrialian Securities Exchange.
The purchase was executed in the form of CDIs, trading on the Austrialian Securities Exchange, and as such the purchase price has been converted to a USD equivalent, adjusting for the conversion ratio of 1 share of common stock per 10 CDIs, and the exchange rate on the date of the transaction.
Represents shares 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. The trustees are children 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.
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.
/s/ Katrina Thompson, Attorney-in-fact
2015-06-04