REVA Medical (RVALL) Form 3 REVA Medical / Leigh Elkolli ownership change

SEC Form 3

FORM 3

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

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person^*

Elkolli Leigh

(Last) (First) (Middle)

C/O REVA MEDICAL, INC.

5751 COPLEY DRIVE, SUITE B

(Street)

SAN DIEGO CA 92111

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
01/03/2019

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

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

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
Chief Financial Officer

5. 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 Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Stock Option (right to buy)	(1)	09/18/2027	Common Stock	17,006	5.88	D
Stock Option (right to buy)	(1)	09/18/2027	Common Stock	32,994	5.88	D
Stock Option (right to buy)	(2)	01/22/2028	Common Stock	20,000	3.875	D

Explanation of Responses:

1. 25% of the shares subject to the option vest on the one year anniversary of September 18, 2017, and 2.08333% of the shares subject to the option vest each month thereafter, on the same day of the month, subject to the reporting person's continued service.

2. 25% of the shares subject to the option vest on the one year anniversary of January 22, 2018, and 2.08333% of the shares subject to the option vest each month thereafter, on the same day of the month, subject to the reporting person's continued service.

Remarks:

	/s/ Leigh Elkolli	01/14/2019
	** 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 5 (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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.