0000769993-17-000590.txt : 20170620 0000769993-17-000590.hdr.sgml : 20170620 20170620162534 ACCESSION NUMBER: 0000769993-17-000590 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170616 FILED AS OF DATE: 20170620 DATE AS OF CHANGE: 20170620 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: 17921092 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: 17921093 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 ownershipdoc06192017093453.xml X0306 4 2017-06-16-04:00 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 Stock Options (right to buy) 2017-06-16-04:00 4 P false 166500 A 2017-06-16-04:00 2022-06-16-04:00 Common Stock, par value $0.0001 per share 166500 166500 I See footnotes 8.00% Convertible Notes 2017-06-16-04:00 4 P false 3700000 A 2022-06-16-04:00 Common Stock, par value $0.0001 per share 3700000 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 June 16, 2017, GSI acquired 166,500 stock options ("Stock Options") which confers the right to subscribe for one share of Reva Medical, Inc. common stock at par value $0.0001 (the "Common Stock") at an exercise price of either: (i) $5.00, if the Stock Option is exercised before an IPO or a pre-IPO share sale with net proceeds to the issuer of greater than $25,000,000 ("Subsequent Financing"); or (ii) if the Stock Option is exercised after an IPO or Subsequent Financing has occurred, the greater of (A) the applicable Subsequent Financing Price or IPO Price (as the case may be), but in no event to exceed $7.212 and (B) $5.00. Consideration was paid jointly by the Reporting Persons for the 166,500 Stock Options and 37 8.00% Convertible Notes for total consideration of $3,700,000. On June 16, 2017, GSI acquired 37 convertible notes with a face value of $100,000 each (the "8.00% Convertible Notes") that are convertible at any time into shares of Common Stock. The conversion price for the 8.00% Convertible Notes will initially be $8.655 per share of common stock (or $0.8655 per CDI), subject to adjustment as further described in the Prospectus for Offering of Convertible Notes and Options dated April 24, 2017. The number of shares of Common Stock to be issued upon conversion of the 8.00% Convertible Notes is determined by dividing the face value of the 8.00% Convertible Note converted by the conversion price in effect on the conversion date. GS Group may be deemed to beneficially own indirectly, an aggregate face value of $3,700,000 of the 8.00% Convertible Notes and 166,500 Stock Options by reason of GSI's direct beneficial ownership of the 8.00% Convertible Notes and the Stock Options. /s/ Yvette Kosic, Attorney-in-fact 2017-06-20-04:00 /s/ Yvette Kosic, Attorney-in-fact 2017-06-20-04:00