0001654954-23-003613.txt : 20230327 0001654954-23-003613.hdr.sgml : 20230327 20230327171844 ACCESSION NUMBER: 0001654954-23-003613 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230323 FILED AS OF DATE: 20230327 DATE AS OF CHANGE: 20230327 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: 23765413 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: 1670 HIGHWAY 160 WEST STREET 2: SUITE 205 CITY: FORT MILL STATE: SC ZIP: 29708 BUSINESS PHONE: 973-691-2000 MAIL ADDRESS: STREET 1: 1670 HIGHWAY 160 WEST STREET 2: SUITE 205 CITY: FORT MILL STATE: SC ZIP: 29708 4 1 section16.xml PRIMARY DOCUMENT X0407 4 2023-03-23 0001716621 Ra Medical Systems, Inc. RMED 0001279803 JENKINS DAVID A C/O RA MEDICAL SYSTEMS, INC. 1670 HIGHWAY 160 WEST, SUITE 205 FORT MILL SC 29708 true true Ex. Chairman of the Board false Common Stock 2023-03-23 4 C false 277597 0 A 277597 D Common Stock 2023-03-23 4 C false 709703 0 A 709703 I See footnote Common Stock 2023-03-23 4 C false 2264 0 A 2264 I See footnote Series X Convertible Preferred Stock 0 2023-03-23 4 C false 277.597 0 D Common Stock 2292339 2292.339 D Series X Convertible Preferred Stock 0 2023-03-23 4 C false 709.703 0 D Common Stock 5860540 5860.540 I See footnote Series X Convertible Preferred Stock 0 2023-03-23 4 C false 2.264 0 D Common Stock 18691 18.691 I See footnote This transaction was the result of the automatic conversion of shares of Series X Preferred upon receipt of stockholder approval. Shares held by a partnership of which the reporting person is the managing member of the managing partner. Shares held by charitable remainder unitrust of which the reporting person's spouse is the trustee. Each share of preferred stock will automatically convert into 1000 shares of common stock on or after July 9, 2024, if the Company satisfies the initial listing standards of a national securities exchange or has been delisted from the NYSE American. Series X Convertible Preferred Stock has no expiration date. /s/ David Jenkins 2023-03-24