0000904454-17-000511.txt : 20170711 0000904454-17-000511.hdr.sgml : 20170711 20170711164207 ACCESSION NUMBER: 0000904454-17-000511 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170709 FILED AS OF DATE: 20170711 DATE AS OF CHANGE: 20170711 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: DOVEY BRIAN H CENTRAL INDEX KEY: 0001207786 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-54192 FILM NUMBER: 17960359 MAIL ADDRESS: STREET 1: ONE PALMER SQUARE CITY: PRINCETON STATE: NJ ZIP: 08542 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2017-07-09 0001496268 REVA Medical, Inc. RVA 0001207786 DOVEY BRIAN H C/O DOMAIN ASSOCIATES, LLC ONE PALMER SQUARE PRINCETON NJ 08542 1 0 0 0 Common Stock 2017-07-09 4 A 0 6000 0 A 23500 D Common Stock 3606002 I By Domain Partners V, L.P. Common Stock 85186 I By DP V Associates, L.P. Common Stock 7500 I By Domain Associates, LLC Stock Option (Right to Buy) 6.45 2017-07-09 4 A 0 10500 0 A 2027-07-09 Common Stock 10500 10500 D Award of Restricted Stock Units, which vest 100% on the earlier of 7/09/2018 or the day prior to the Issuer's 2018 Annual Meeting of Shareholders, provided the Reporting Person remains in service to the Issuer to such vesting date. Each Restricted Stock Unit entitles the holder to one share of Common Stock upon vesting. The Reporting Person is a Managing Member of One Palmer Square Associates V, LLC, which is the sole general partner of Domain Partners V, L.P. and DP V Associates, L.P., and a Managing Member of Domain Associates, LLC. The Reporting Person has elected to report as indirectly beneficially owned the entire number of securities beneficially owned by each such entity. The Reporting Person disclaims beneficial ownership of any securities, and any proceeds thereof, that exceed his pecuniary interest therein and/or that are not actually distributed to him. The Options vest in equal quarterly installments on 10/09/2017, 1/09/2018, 4/09/2018 and 7/09/2018, provided the Reporting Person remains in service to the Issuer to each such vesting date. /s/ Lisa A. Kraeutler, Attorney-in-Fact 2017-07-11