0001209191-19-059368.txt : 20191205
0001209191-19-059368.hdr.sgml : 20191205
20191205182003
ACCESSION NUMBER: 0001209191-19-059368
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191203
FILED AS OF DATE: 20191205
DATE AS OF CHANGE: 20191205
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Jackson Andrew C.
CENTRAL INDEX KEY: 0001636738
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38677
FILM NUMBER: 191271353
MAIL ADDRESS:
STREET 1: 11988 EL CAMINO REAL STE. 650
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
2019-12-03
0
0001716621
Ra Medical Systems, Inc.
RMED
0001636738
Jackson Andrew C.
C/O RA MEDICAL SYSTEMS, INC.
2070 LAS PALMAS DRIVE
CARLSBAD
CA
92011
0
1
0
0
CFO & Interim CEO
Common Stock
2019-12-04
4
F
0
4505
1.69
D
29843
D
Stock Option (Right to Buy)
1.22
2019-12-03
4
A
0
139052
0.00
A
2029-12-03
Common Stock
139052
139052
D
Shares withheld by the issuer to satisfy the mandatory tax withholding requirement upon vesting of restricted stock units. This is not an open market sale of securities.
Of the reported shares 13,424 shares are represented by Restricted Stock Units.
1/12 of the total shares subject to the option shall vest every month after December 3, 2019, such that all shares subject to the option shall be fully vested on December 3, 2020, subject to the Reporting Person continuing to be a "Service Provider" (as defined in the Company's 2018 Equity Incentive Plan) through each vesting date.
/s/ Daniel Horwood, as Attorney-in-Fact
2019-12-05