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