0001209191-21-066775.txt : 20211124
0001209191-21-066775.hdr.sgml : 20211124
20211124160353
ACCESSION NUMBER: 0001209191-21-066775
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211120
FILED AS OF DATE: 20211124
DATE AS OF CHANGE: 20211124
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: 211446384
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
2021-11-20
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
Common Stock
2021-11-20
4
D
0
11759
0.00
D
25725
D
Common Stock
2021-11-22
4
S
0
2684
2.62
D
23041
D
Represents forfeiture of shares underlying restricted stock award granted on November 17, 2020.
Shares sold to satisfy the tax withholding requirement upon vesting of restricted stock awards.
/s/ Andrew Jackson
2021-11-24