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