SEC Form 4 · accession 0001209191-15-060355
REVA Medical, Inc. · RVA:AX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Robert K. Schultz
Officer — President & COO
Period of report
Jul 7, 2015
Accepted (ET)
Jul 9, 2015 · 9:04 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001496268
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Jul 7, 2015 | M | 80,000 | $1.25 | A | 311,500 | D | |
| Common StockF1 | holding | — | — | — | 5,000 | I | The Schultz Family Trust dtd 10/20/2000 |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy) | $1.25 | Jul 7, 2015 | M | 80,000 | D | Jul 13, 2005 | Jul 13, 2015 | Common Stock | 80,000 | 0 | D |
Explanation of responses
- F1Mr. Schultz, along with Patricia Schultz, is the trustee of the The Schultz Family Trust dtd 10/20/2000 and has voting and dispositive power with respect to these shares. Mr. Shultz disclaims beneficial ownership except to the extent of his pecuniary interest therein.