0001209191-23-003033.txt : 20230111
0001209191-23-003033.hdr.sgml : 20230111
20230111172041
ACCESSION NUMBER: 0001209191-23-003033
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230109
FILED AS OF DATE: 20230111
DATE AS OF CHANGE: 20230111
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: JENKINS DAVID A
CENTRAL INDEX KEY: 0001279803
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38677
FILM NUMBER: 23524260
MAIL ADDRESS:
STREET 1: P.O. BOX 682838
CITY: PARK CITY
STATE: UT
ZIP: 84068
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
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 5857 OWENS DRIVE, SUITE 300
CITY: CARLSBAD
STATE: CA
ZIP: 92009
BUSINESS PHONE: (760) 804-1648
MAIL ADDRESS:
STREET 1: 5857 OWENS DRIVE, SUITE 300
CITY: CARLSBAD
STATE: CA
ZIP: 92009
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2023-01-09
0
0001716621
Ra Medical Systems, Inc.
RMED
0001279803
JENKINS DAVID A
C/O RA MEDICAL SYSTEMS, INC.
5857 OWENS DRIVE, SUITE 300
CARLSBAD
CA
92009
1
1
0
0
Executive Chairman of Board
Series X Convertible Preferred Stock
2023-01-09
4
A
0
2569.936
A
Common Stock
2569936
2569.936
D
Series X Convertible Preferred Stock
2023-01-09
4
A
0
20.955
A
Common Stock
20955
20.955
I
See footnote
Series X Convertible Preferred Stock
2023-01-09
4
A
0
6570.243
A
Common Stock
6570243
6570.243
I
See footnote
Following stockholder approval of the conversion of Series X Convertible Preferred Stock into shares of Common Stock, each share of Series X Convertible Preferred Stock automatically converts into 1,000 shares of Common Stock, subject to certain limitations.
On January 9, 2023, the Issuer, completed its acquisition of Catheter Precision, Inc., a privately-held Delaware corporation ("Catheter"), pursuant to an Amended and Restated Agreement and Plan of Merger (the "Merger"). In connection with the Merger, each share of Catheter common stock previously outstanding held by the reporting person now represents a number of shares of Series X Convertible Preferred Stock equal to approximately 0.6697, divided by one thousand (1,000).
Series X Convertible Preferred Stock has no expiration date
Shares held by charitable remainder unitrust of which the reporting person's spouse is the trustee.
Shares held by a partnership of which the reporting person is the managing member of the managing partner.
/s/ Will McGuire, as Attorney-in-Fact
2023-01-11