0001209191-18-054439.txt : 20181005 0001209191-18-054439.hdr.sgml : 20181005 20181005181506 ACCESSION NUMBER: 0001209191-18-054439 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181004 FILED AS OF DATE: 20181005 DATE AS OF CHANGE: 20181005 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: COLOMBATTO MARTIN J CENTRAL INDEX KEY: 0001208236 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38677 FILM NUMBER: 181111520 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Ra Medical Systems, Inc. CENTRAL INDEX KEY: 0001716621 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 363661826 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2070 LAS PALMAS DRIVE CITY: CARLSBAD STATE: CA ZIP: 92011 BUSINESS PHONE: (760) 804-1648 MAIL ADDRESS: STREET 1: 2070 LAS PALMAS DRIVE CITY: CARLSBAD STATE: CA ZIP: 92011 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-10-04 0 0001716621 Ra Medical Systems, Inc. RMED 0001208236 COLOMBATTO MARTIN J C/O RA MEDICAL SYSTEMS, INC. 2070 LAS PALMAS DRIVE CARLSBAD CA 92011 1 0 0 0 Common Stock 2018-10-04 4 A 0 8235 0.00 A 38625 D Common Stock 37500 I See Footnote Reported shares are represented by restricted stock units ("RSUs"), and each RSU is the economic equivalent of one share of Ra Medical Systems, Inc. common stock. 1/3rd of the RSUs shall vest annually beginning on October 4, 2019 such that the RSUs will be fully vested on October 4, 2021, subject to the reporting person's continued service. Shares held of record by the M Colombatto Trust, for which the reporting person serves as Trustee. /s/ Andrew Jackson, as Attorney-in-Fact 2018-10-05