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