0001209191-18-052292.txt : 20180926 0001209191-18-052292.hdr.sgml : 20180926 20180926162914 ACCESSION NUMBER: 0001209191-18-052292 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 3 CONFORMED PERIOD OF REPORT: 20180926 FILED AS OF DATE: 20180926 DATE AS OF CHANGE: 20180926 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Burstein Martin CENTRAL INDEX KEY: 0001748671 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38677 FILM NUMBER: 181088240 MAIL ADDRESS: STREET 1: C/O RA MEDICAL SYSTEMS, INC. STREET 2: 2070 LAS PALMAS DRIVE CITY: CARLSBAD STATE: CA ZIP: 92011 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Martin Burstein Living Trust Dated January 28, 2002 CENTRAL INDEX KEY: 0001748362 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38677 FILM NUMBER: 181088241 BUSINESS ADDRESS: STREET 1: C/O RA MEDICAL SYSTEMS, INC. STREET 2: 2070 LAS PALMAS DRIVE CITY: CARLSBAD STATE: CA ZIP: 92011 BUSINESS PHONE: 760-804-1648 MAIL ADDRESS: STREET 1: C/O RA MEDICAL SYSTEMS, INC. STREET 2: 2070 LAS PALMAS DRIVE CITY: CARLSBAD STATE: CA ZIP: 92011 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Ra Medical Systems, Inc. CENTRAL INDEX KEY: 0001716621 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 363661826 STATE OF INCORPORATION: CA 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 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2018-09-26 0 0001716621 Ra Medical Systems, Inc. RMED 0001748671 Burstein Martin C/O RA MEDICAL SYSTEMS, INC. 2070 LAS PALMAS DRIVE CARLSBAD CA 92011 0 0 1 0 0001748362 Martin Burstein Living Trust Dated January 28, 2002 C/O RA MEDICAL SYSTEMS, INC. 2070 LAS PALMAS DRIVE CARLSBAD CA 92011 0 0 1 0 Common Stock 179250 D Common Stock 1604500 I See Footnote Common Stock 350000 I See Footnote Stock Option (Right to Buy) 28.94 2028-06-04 Common Stock 42000 D Stock Option (Right to Buy) 28.94 2028-06-04 Common Stock 150000 D Reported shares are represented by restricted stock units ("RSUs"), and each RSU is the economic equivalent of one share of Ra Medical Systems, Inc. common stock. 148,860 of the RSUs shall vest as follows: 15% of the RSUs shall vest on the 10th day of the first month following the expiration of the Lock-Up Period (as defined in the award agreement) (the "LP"), 15% of the RSUs shall vest on the 10th day of the second month following the expiration of the LP, 15% of the RSUs shall vest on the 15th day of the fourth month following the expiration of the LP, 15% of the RSUs shall vest on the 15th day of the fifth month following the expiration of the LP, 15% of the RSUs shall vest on the 20th day of the seventh month following the expiration of the LP, 15% of the RSUs shall vest on the 20th day of the eighth month following the expiration of the LP, and 10% of the RSUs shall vest on the 25th day of the tenth month following the expiration of the LP, subject to the reporting persons continued service. The remaining 30,390 RSUs shall vest as follows: 33% of the RSUs shall vest on the 10th day of the third month following the expiration of the LP, 33% of the RSUs shall vest on the 15th day of the sixth month following the expiration of the LP, and 34% of the RSUs shall vest on the 20th day of the ninth month following the expiration of the LP, subject to the reporting person's continued service. In the event of a Change in Control (as defined in the Issuer's 2018 Stock Compensation Plan (the "Compensation Plan")), 100% of the RSUs shall immediately become fully vested, subject to the reporting person's continued service. Reported shares held of record by Martin Burstein Living Trust dated January 28, 2002, of which Martin Burstein is the sole trustee. Reported shares held of record by Karen Jorgensen Burstein Family Trust Dated November 10, 2000, of which Martin Burstein's spouse is the sole trustee. One thirty-sixth of the shares subject to the option vest each month over the thirty six months following January 1, 2017, on the same day of the month, subject to the reporting person's continued service. In the event of a Change in Control (as defined in the Compensation Plan), one hundred percent (100%) of the shares subject to the option shall immediately vest. One-third of the shares subject to the option shall vest on June 4, 2019, and one thirty-sixth of the shares subject to the option shall vest monthly thereafter, subject to the reporting person's continued service. Exhibit 24 - Powers of Attorney /s/ Andrew Jackson, as Attorney-in-Fact on behalf of Martin Burstein 2018-09-26 /s/ Andrew Jackson, as Attorney-in-Fact on behalf of Martin Burstein Living Trust dated January 28, 2002 2018-09-26 EX-24 2 attachment1.htm EX-24 DOCUMENT 
Exhibit 24

POWER OF ATTORNEY
The undersigned, as a Section 16 reporting person of Ra Medical Systems, Inc.
(the "Company"), hereby constitutes and appoints Dean Irwin, Melissa Burstein,
Andrew Jackson, Daniel Sanchez-Linares, Jeffrey Kraws, Martin J. Waters, Zachary
Myers, Kathryn Fortin, and Mahnaz Daruwalla the undersigned's true and lawful
attorneys-in-fact to:
1.	complete and execute Forms 3, 4 and 5 and other forms and all amendments
thereto as such attorneys-in-fact shall in their discretion determine to be
required or advisable pursuant to Section 16 of the Securities Exchange Act of
1934 (as amended) and the rules and regulations promulgated thereunder, or any
successor laws and regulations, as a consequence of the undersigned's ownership,
acquisition or disposition of securities of the Company; and
2.	do all acts necessary in order to file such forms with the Securities and
Exchange Commission, any securities exchange or national association, the
Company and such other person or agency as the attorneys-in-fact shall deem
appropriate.
The undersigned hereby ratifies and confirms all that said attorneys in-fact and
agent shall do or cause to be done by virtue hereof.  The undersigned
acknowledges that the foregoing attorneys-in-fact, in serving in such capacity
at the request of the undersigned, is not assuming, nor is the Company assuming,
any of the undersigned's responsibilities to comply with Section 16 of the
Securities Exchange Act of 1934 (as amended).
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
Company and the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 26th day of July, 2018.
Signature:  /s/ Martin Burstein
Print Name:  Martin Burstein
EX-24 3 attachment2.htm EX-24 DOCUMENT 
Exhibit 24

POWER OF ATTORNEY
The undersigned, as a Section 16 reporting person of Ra Medical Systems, Inc.
(the "Company"), hereby constitutes and appoints Dean Irwin, Melissa Burstein,
Andrew Jackson, Daniel Sanchez-Linares, Jeffrey Kraws, Martin J. Waters, Zachary
Myers, Kathryn Fortin, and Mahnaz Daruwalla the undersigned's true and lawful
attorneys-in-fact to:
1.	complete and execute Forms 3, 4 and 5 and other forms and all amendments
thereto as such attorneys-in-fact shall in their discretion determine to be
required or advisable pursuant to Section 16 of the Securities Exchange Act of
1934 (as amended) and the rules and regulations promulgated thereunder, or any
successor laws and regulations, as a consequence of the undersigned's ownership,
acquisition or disposition of securities of the Company; and
2.	do all acts necessary in order to file such forms with the Securities and
Exchange Commission, any securities exchange or national association, the
Company and such other person or agency as the attorneys-in-fact shall deem
appropriate.
The undersigned hereby ratifies and confirms all that said attorneys in-fact and
agent shall do or cause to be done by virtue hereof.  The undersigned
acknowledges that the foregoing attorneys-in-fact, in serving in such capacity
at the request of the undersigned, is not assuming, nor is the Company assuming,
any of the undersigned's responsibilities to comply with Section 16 of the
Securities Exchange Act of 1934 (as amended).
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
Company and the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 26th day of July, 2018.
Martin Burstein Living Trust Dated January 28, 2002
Signature: /s/ Martin Burstein
Print Name: Martin Burstein, Trustee