0000769993-17-000516.txt : 20170509
0000769993-17-000516.hdr.sgml : 20170509
20170509203656
ACCESSION NUMBER: 0000769993-17-000516
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20170505
FILED AS OF DATE: 20170509
DATE AS OF CHANGE: 20170509
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: 17828200
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: 17828201
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
ownershipdoc05012017091221.xml
X0306
4
2017-05-05-04:00
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)
2017-05-05-04:00
4
P
false
171000
A
2017-05-05-04:00
2022-05-02-04:00
Common Stock, par value $0.0001 per share
171000
171000
I
See footnotes
8.00% Convertible Notes
2017-05-05-04:00
4
P
false
3800000
A
2022-05-02-04:00
Common Stock, par value $0.0001 per share
3800000
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 May 5, 2017, GSI acquired 171,000 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 171,000 Stock Options and 38 8.00% Convertible Notes for total consideration of $3,800,000.
On May 5, 2017, GSI acquired 38 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 $3,800,000 of the 8.00% Convertible Notes and 171,000 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
2017-05-09-04:00
/s/ Yvette Kosic, Attorney-in-fact
2017-05-09-04:00