SEC Form 4 · accession 0000904454-17-000511

REVA Medical, Inc. · RVA:AX

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Jul 9, 2017

Accepted (ET)

Jul 11, 2017 · 4:42 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 Stock^F1	Jul 9, 2017	A	6,000	$0.00	A	23,500	D
Common Stock^F2	holding	—	—		—	3,606,002	I	By Domain Partners V, L.P.
Common Stock^F2	holding	—	—		—	85,186	I	By DP V Associates, L.P.
Common Stock^F2	holding	—	—		—	7,500	I	By Domain Associates, LLC

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Stock Option (Right to Buy)^F3	$6.45	Jul 9, 2017	A	10,500	A	—	Jul 9, 2027	Common Stock	10,500	10,500	D

F1Award 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.
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., 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.
F3The 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.