0001209191-20-059505.txt : 20201119 0001209191-20-059505.hdr.sgml : 20201119 20201119182915 ACCESSION NUMBER: 0001209191-20-059505 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201119 FILED AS OF DATE: 20201119 DATE AS OF CHANGE: 20201119 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stafslien Joan CENTRAL INDEX KEY: 0001467816 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38677 FILM NUMBER: 201329955 MAIL ADDRESS: STREET 1: CAREFUSION CORPORATION STREET 2: 3750 TORREY VIEW COURT CITY: SAN DIEGO STATE: CA ZIP: 92130 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 2020-11-19 0 0001716621 Ra Medical Systems, Inc. RMED 0001467816 Stafslien Joan C/O RA MEDICAL SYSTEMS, INC. 2070 LAS PALMAS DRIVE CARLSBAD CA 92011 1 0 0 0 Common Stock 2020-11-19 4 P 0 4410 5.6695 A 4410 I See Footnote Common Stock 5000 D Represents the weighted average share price of an aggregate total of 4,410 shares purchased in the price range of $5.54 to $5.80 by the reporting person. The reporting person undertakes to provide upon request by the Commission staff, the issuer or a security holder of the issuer, full information regarding the number of shares purchased at each separate price. Shares held of record by the Thomas & Joan Stafslien Family B Trust dated 6/17/1997, for which the reporting person serves as trustee. On November 16, 2020, the common stock of the company reverse-split 25-for-1, resulting in the reporting persons ownership being reduced by 120,000. /s/ Daniel Horwood, as Attorney-in-Fact 2020-11-19