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