0001209191-21-002572.txt : 20210107 0001209191-21-002572.hdr.sgml : 20210107 20210107180334 ACCESSION NUMBER: 0001209191-21-002572 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210105 FILED AS OF DATE: 20210107 DATE AS OF CHANGE: 20210107 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: 21515079 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Ra Medical Systems, Inc. CENTRAL INDEX KEY: 0001716621 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 383661826 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 2021-01-05 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 2021-01-05 4 A 0 10000 0.00 A 25439 D Common Stock 1500 I See Footnote The Reporting Person has elected to receive his 2021 retainer compensation in restricted stock, rather than cash. Subject to the Reporting Person continuing to be a "Service Provider" (as defined in the Company's 2018 Equity Incentive Plan) through each vesting date, the shares shall vest as follows: 25% of the shares subject to the restricted stock award shall vest quarterly on the fifth of the month immediately following the end of the quarter corresponding with the date of grant (i.e. April 5, 2021, July 5, 2021, October 5, 2021, and January 5, 2022), such that the shares shall be fully vested on January 5, 2022. Shares held of record by the M Colombatto Trust, for which the reporting person serves as trustee. /s/ Daniel Horwood, as Attorney-in-Fact 2021-01-07