-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, R9hiAPpBPWupaqqD3jOFw+XSW+mDBVj4j9eid981y6ryefXqlohxLB60crMBse0k QuvKNFNcuIO8Iphbz3GBWw== 0000904454-11-000006.txt : 20110204 0000904454-11-000006.hdr.sgml : 20110204 20110204093332 ACCESSION NUMBER: 0000904454-11-000006 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20110204 DATE AS OF CHANGE: 20110204 SUBJECT COMPANY: 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 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-85775 FILM NUMBER: 11572704 BUSINESS ADDRESS: STREET 1: 5751 COPLEY DRIVE, SUITE B CITY: SAN DIEGO STATE: CA ZIP: 92111 BUSINESS PHONE: (858) 966-3000 MAIL ADDRESS: STREET 1: 5751 COPLEY DRIVE, SUITE B CITY: SAN DIEGO STATE: CA ZIP: 92111 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: DOMAIN PARTNERS V LP CENTRAL INDEX KEY: 0001207785 IRS NUMBER: 000000000 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: ONE PALMER SQUARE CITY: PRINCETON STATE: NJ ZIP: 08542 BUSINESS PHONE: 6096835656 MAIL ADDRESS: STREET 1: ONE PALMER SQUARE CITY: PRINCETON STATE: NJ ZIP: 08542 SC 13G 1 s13g_020311-reva.htm SCHEDULE 13G Unassociated Document
 
 
CUSIP No. 76133E 10 9 Page 1 of 8 Pages



SECURITIES AND EXCHANGE COMMISSION
Washington, D.C.  20549
_____________________

SCHEDULE 13G
(Rule 13d-102)

INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT
TO RULES 13d-1(b),(c) AND (d) AND AMENDMENTS THERETO FILED
PURSUANT TO RULE 13d-2(b)
(Amendment No.  )1

REVA Medical, Inc.
(Name of Issuer)

Common Stock, $.0001 par value
(Title of Class of Securities)

76133E 10 9
(CUSIP Number)

November 15, 2010
Date of Event Which Requires Filing of this Statement

Check the appropriate box to designate the rule pursuant to which this Schedule is Filed:

[ ] Rule 13d-1(b)
[ ] Rule 13d-1(c)
[X] Rule 13d-1(d)




_______________________

1The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page.  The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act.

 
 

 
CUSIP No. 76133E 10 9 Page 2 of 8 Pages


1)
Name of Reporting Person
I.R.S. Identification
No. of Above Person
(Entities Only)
Domain Partners V, L.P.
2)
Check the Appropriate Box
if a Member of a Group
(a) [X]
(b) [ ]
3)
SEC Use Only
 
4)
Citizenship or Place
of Organization
Delaware
Number of
Shares Beneficially
Owned by Each
Reporting Person
With
5)
Sole Voting
Power
5,262,583 shares of Common Stock
6)
Shared Voting
Power
 
-0-
7)
Sole Dispositive
Power
5,262,583 shares of Common Stock
8)
Shared Dispositive Power
 
-0-
9)
Aggregate Amount Beneficially Owned by Each Reporting Person
5,262,583 shares of Common Stock
10)
Check if the Aggregate Amount in Row (9) Excludes Certain Shares
 
11)
Percent of Class Represented by Amount in Row (9)
16.1%
12)
Type of Reporting Person
PN

 
 

 
CUSIP No. 76133E 10 9 Page 3 of 8 Pages


1)
Name of Reporting Person
I.R.S. Identification
No. of Above Person
(Entities Only)
DP V Associates, L.P.
2)
Check the Appropriate Box
if a Member of a Group
(a) [X]
(b) [ ]
3)
SEC Use Only
 
4)
Citizenship or Place
of Organization
Delaware
Number of
Shares Beneficially
Owned by Each
Reporting Person
With
5)
Sole Voting
Power
124,322 shares of Common Stock
6)
Shared Voting
Power
 
-0-
7)
Sole Dispositive
Power
124,322 shares of Common Stock
8)
Shared Dispositive Power
 
-0-
9)
Aggregate Amount Beneficially Owned by Each Reporting Person
124,322 shares of Common Stock
10)
Check if the Aggregate Amount in Row (9) Excludes Certain Shares
 
11)
Percent of Class Represented by Amount in Row (9)
0.4%
12)
Type of Reporting Person
PN


 
 

 
CUSIP No. 76133E 10 9 Page 4 of 8 Pages

Schedule 13G

Item 1(a)                 –      Name of Issuer:  REVA Medical, Inc.

Item 1(b)                 –      Address of Issuer’s Principal Executive Offices:

5751 Copley Drive, Suite B
San Diego, CA  92111

Item 2(a)                 –      Name of Person Filing:

 
This statement is being filed by Domain Partners V, L.P., a Delaware limited partnership (“Domain V”), and DP V Associates, L.P., a Delaware limited partnership (“DP V A”) (together, the “Reporting Persons”).

 
Item 2(b)
Address of Principal Business Office:

 
One Palmer Square
 
Princeton, NJ  08542

 
Item 2(c)
Place of Organization:

 
Domain V:  Delaware
 
DP V A:  Delaware

 
Item 2(d)
Title of Class of Securities:

 
Common Stock, $.0001 par value

 
Item 2(e)
CUSIP Number:  76133E 10 9

 
Item 3
Statements Filed Pursuant to Rules 13d-1(b) or 13d-2(b):

 
Not applicable.

 
Item 4
Ownership.

(a) Amount Beneficially Owned:

Domain V:  5,262,583 shares of Common Stock
DP V A:  124,322 shares of Common Stock

(b) Percent of Class:

Domain V:  16.1%
DP V A:  0.4%

 
 

 
CUSIP No. 76133E 10 9 Page 5 of 8 Pages


(c)           Number of shares as to which such person has:

(i)           sole power to vote or to direct the vote:

Domain V:  5,262,583 shares of Common Stock
DP V A:  124,322 shares of Common Stock

(ii) shared power to vote or to direct the vote:  -0-

(iii) sole power to dispose or to direct the disposition of:

Domain V:  5,262,583 shares of Common Stock
DP V A:  124,322 shares of Common Stock

(iv)  shared power to dispose or to direct the disposition of:  -0-

 
Item 5
Ownership of Five Percent or Less of a Class:

Not applicable.

 
Item 6
Ownership of More than Five Percent on Behalf of Another Person:

Not applicable.

 
Item 7
Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Company:

 
Not applicable.

 
Item 8
Identification and Classification of Members of the Group:

 
See Exhibit 2.

 
Item 9
Notice of Dissolution of Group:

 
Not applicable.

 
Item 10
Certification:

 
Not applicable.

 
 

 
CUSIP No. 76133E 10 9 Page 6 of 8 Pages

Signature:

After reasonable inquiry and to the best of their knowledge and belief, the undersigned hereby certify that the information set forth in this statement is true, complete and correct.

 
DOMAIN PARTNERS V, L.P.
 
 
By:
One Palmer Square Associates V, L.L.C., General Partner
 
 
By:
/s/ Kathleen K. Schoemaker
   
Managing Member
 
 
 
DP V ASSOCIATES, L.P.
 
 
By:
One Palmer Square Associates V, L.L.C., General Partner
 
 
By:
/s/ Kathleen K. Schoemaker
   
Managing Member

Date:  February 3, 2011


 
 

 
CUSIP No. 76133E 10 9 Page 7 of 8 Pages

 EXHIBIT 2

 
JOINT FILING AGREEMENT
 
 
The undersigned hereby agree that the statement on Schedule 13G to which this Agreement is annexed as Exhibit 2, and any amendments thereto, is and will be filed on behalf of each of them in accordance with the provisions of Rule 13d-1(k) under the Securities Exchange Act of 1934, as amended.
 

 
DOMAIN PARTNERS V, L.P.
 
 
By:
One Palmer Square Associates V, L.L.C., General Partner
 
 
By:
/s/ Kathleen K. Schoemaker
   
Managing Member
 
 
 
DP V ASSOCIATES, L.P.
 
 
By:
One Palmer Square Associates V, L.L.C., General Partner
 
 
By:
/s/ Kathleen K. Schoemaker
   
Managing Member

Date: February 3, 2011

 
 

 
CUSIP No. 76133E 10 9 Page 8 of 8 Pages

 EXHIBIT 2

    Identification and Classification of Members of the Group

Domain Partners V, L.P. and DP V Associates, L.P. are filing this statement on Schedule 13G as a group.

Domain Partners V, L.P. is a Delaware limited partnership.  Its sole general partner is One Palmer Square Associates V, L.L.C., a Delaware limited liability company.

DP V Associates, L.P. is a Delaware limited partnership.  Its sole general partner is One Palmer Square Associates V, L.L.C., a Delaware limited liability company.

 

 

 
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