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*
SAINTS CAPITAL EVEREST LP

(Last) (First) (Middle)
475 SANSOME STREET
SUITE 1850

(Street)
SAN FRANCISCO CA 94111

(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)
Director X 10% Owner
Officer (give title below) Other (specify below)
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)
Code V Amount (A) or (D) Price
Common Stock 12/16/2010 C 1,204,180 A (1) 1,204,180 D
Common Stock 12/16/2010 C 102,883 A (2) 1,307,063 D
Common Stock 12/16/2010 X(4) 17,147 A $6.5066 1,324,210 D
Common Stock 12/16/2010 F(4) 10,185 D $10.9538 1,314,025 D
Common Stock 12/16/2010 X(5) 3,430 A $6.5066 1,317,455 D
Common Stock 12/16/2010 F(5) 2,037 D $10.9538 1,315,418 D
Common Stock 12/16/2010 C(6) 3,158,164(6) A $6.5066 4,473,582 D
Common Stock 12/16/2010 P 90,909 A $1.1(7) 4,564,491 D
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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series G-1 Preferred Stock (1) 12/16/2010 C 1,204,180 (1) (3) Common Stock 1,204,180 (1) 0 D
Series H Preferred Stock (2) 12/16/2010 C 102,883 (2) (3) Common Stock 102,883 (2) 0 D
Warrant (right to buy) $6.5066 12/16/2010 X(4) 17,147 05/25/2010 12/07/2012 Common Stock 17,147 $0 0 D
Warrant (right to buy) $6.5066 12/16/2010 X(5) 3,430 06/02/2010 12/07/2012 Common Stock 3,430 $0 0 D
Convertible Note $6.5066 12/16/2010 C(6) 3,146,911 06/08/2005 12/31/2011 Common Stock 3,146,911 $0 0 D
Explanation of Responses:
1. Each share of Series G-1 Preferred Stock was automatically converted into 1.187321 shares of Common Stock upon closing of the Issuer's initial public offering.
2. Each share of Series H Preferred Stock was automatically converted into one share of Common Stock upon the closing of the Issuer's initial public offering.
3. The Series G-1 and H Preferred Stock have no expiration date.
4. Reflects the cashless exercise of the warrant, resulting in the issuance to the Reporting Person of 6,962 shares of common stock and cancellation of the warrant with respect to the balance of 10,185 shares of common stock.
5. Reflects the cashless exercise of the warrant, resulting in the issuance to the Reporting Person of 1,393 shares of common stock and cancellation of the warrant with respect to the balance of 2,037 shares of common stock.
6. The outstanding principal and accrued and unpaid interest on these convertible promissory notes automatically converted into shares of common stock upon the closing of the Issuer's initial public offering, at $6.5066 per share.
7. Represents the U.S. dollar price paid for 90,909 shares of common stock purchased on the Australian Stock Exchange in the form of Chess Depositary Interests ("CDIs") on December 16, 2010. The purchaser price per CDI of $1.10 was calculated using the Aus.$/U.S.$ exchange rate on December 7, 2010 of 0.9983.
Scott Halsted 12/21/2010
** 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).
** 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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