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