0000769993-16-001470.txt : 20160217 0000769993-16-001470.hdr.sgml : 20160217 20160217195523 ACCESSION NUMBER: 0000769993-16-001470 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160212 FILED AS OF DATE: 20160217 DATE AS OF CHANGE: 20160217 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: GOLDMAN SACHS INTERNATIONAL CENTRAL INDEX KEY: 0000908777 STATE OF INCORPORATION: X0 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-54192 FILM NUMBER: 161435664 BUSINESS ADDRESS: STREET 1: PETERBOROUGH COURT STREET 2: 133 FLEET STREET CITY: LONDON STATE: X0 ZIP: EC4A 2BB BUSINESS PHONE: 44 20 7774 1000 MAIL ADDRESS: STREET 1: PETERBOROUGH COURT STREET 2: 133 FLEET STREET CITY: LONDON STATE: X0 ZIP: EC4A 2BB FORMER NAME: FORMER CONFORMED NAME: GOLDMAN SACHS INTERNATIONAL LTD DATE OF NAME CHANGE: 19940315 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GOLDMAN SACHS GROUP INC CENTRAL INDEX KEY: 0000886982 STANDARD INDUSTRIAL CLASSIFICATION: SECURITY BROKERS, DEALERS & FLOTATION COMPANIES [6211] STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-54192 FILM NUMBER: 161435665 BUSINESS ADDRESS: STREET 1: 200 WEST STREET CITY: NEW YORK STATE: NY ZIP: 10282 BUSINESS PHONE: 2129021000 MAIL ADDRESS: STREET 1: 200 WEST STREET CITY: NEW YORK STATE: NY ZIP: 10282 FORMER NAME: FORMER CONFORMED NAME: GOLDMAN SACHS GROUP INC/ DATE OF NAME CHANGE: 20010104 4 1 ownershipdoc02162016121326.xml X0306 4 2016-02-12-05:00 false 0001496268 REVA Medical, Inc. RVA:AX 0000886982 GOLDMAN SACHS GROUP INC 200 WEST STREET NEW YORK NY 10282 false false true false 0000908777 GOLDMAN SACHS INTERNATIONAL PETERBOROUGH COURT 133 FLEET STREET LONDON EC4A 2BB false false true false Common Stock, par value $0.0001 per share 2016-02-12-05:00 4 X false 4375000 2.6 A 4375000 I See footnotes Stock Options (right to buy) 2.6 2016-02-12-05:00 4 X false 4375000 D 2019-11-14-05:00 Common Stock, par value $0.0001 per share 4375000 0 I See footnotes 7.54% Convertible Notes 2019-11-14-05:00 Common Stock, par value $0.0001 per share 125 I See footnotes This statement is being filed by The Goldman Sachs Group, Inc. ("GS Group") and Goldman Sachs International ("GSI" and, together with GS Group, the "Reporting Persons"). GSI is a wholly-owned subsidiary of GS Group. The Reporting Persons disclaim beneficial ownership of the securities reported herein except to the extent of their pecuniary interest therein, if any. On February 12, 2016, GSI exercised 100% of 4,375,000 options (the "Options") to purchase the common stock, par value $0.0001 per share (the "Common Stock") of Reva Medical, Inc. (the "Company") at a purchase price of A$3.00/US$2.60 per share. Total purchase price of Common Stock upon exercise of the Options was $11,406,937.50. The 125 convertible notes with a face value of $100,000 each (the "Convertible Notes") are convertible at any time into shares of Common Stock. The conversion price for the Convertible Notes will initially be A$2.50 per share, subject to adjustment as further described in the Prospectus for Offering of Convertible Notes and Options, dated October 24, 2014 (the "Prospectus"). The number of shares of Common Stock to be issued upon conversion of the Convertible Notes is determined by dividing the face value of the Convertible Note converted (translated from US dollars into Australian dollars at the exchange rate fixed on the subscription date for the Convertible Note) by the conversion price in effect on the conversion date. GS Group may be deemed to beneficially own indirectly, $12,500,000 aggregate principal value of the Convertible Notes, by reason of GSI's direct beneficial ownership of the Convertible Notes. GS Group may also be deemed to beneficially own indirectly 4,375,000 shares of Common Stock by reason of GSI's direct beneficial ownership of the shares of Common Stock. /s/ Yvette Kosic, Attorney-in-fact 2016-02-17-05:00 /s/ Yvette Kosic, Attorney-in-fact 2016-02-17-05:00