SEC Form 4 · accession 0000904454-16-001233
REVA Medical, Inc. · RVA:AX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Brian H Dovey
Director
Period of report
May 25, 2016
Accepted (ET)
May 27, 2016 · 5:01 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001496268
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | May 25, 2016 | A | 10,000 | $0.00 | A | 25,000 | D | |
| Common StockF2 | holding | — | — | — | 3,606,002 | I | By Domain Partners V, L.P. | |
| Common StockF2 | holding | — | — | — | 85,186 | I | By DP V Associates, L.P. |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F3 | $8.30 | May 25, 2016 | A | 11,800 | A | — | May 25, 2026 | Common Stock | 11,800 | 11,800 | D |
Explanation of responses
- F1Award of Restricted Stock Units, which vest 100% on the earlier of the one year anniversary of the date of award or one day before the Issuer's 2017 Annual Meeting of Shareholders, and will be settled in the same number of shares of Common Stock.
- F2The 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. 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 or her pecuniary interest therein and/or that are not actually distributed to him or her.
- F3The Options vest in equal quarterly installments over a one year period beginning on 08/25/2016.