0001209191-18-052299.txt : 20180926 0001209191-18-052299.hdr.sgml : 20180926 20180926164715 ACCESSION NUMBER: 0001209191-18-052299 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20180926 FILED AS OF DATE: 20180926 DATE AS OF CHANGE: 20180926 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Irwin Dean CENTRAL INDEX KEY: 0001746687 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38677 FILM NUMBER: 181088380 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 0001746687 Irwin Dean C/O RA MEDICAL SYSTEMS, INC. 2070 LAS PALMAS DRIVE CARLSBAD CA 92011 1 1 1 0 See Remarks Common Stock 248100 D Common Stock 2803852 I See Footnote Common Stock 148860 I By Spouse Stock Option (Right to Buy) 28.94 2028-06-04 Common Stock 250000 D Stock Option (Right to Buy) 28.94 2028-06-04 Common Stock 150000 I By Spouse 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. 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 applicable holder's continued service. In the event of a Change in Control (as defined in the Issuer's 2018 Stock Compensation Plan), 100% of the RSUs shall immediately become fully vested, subject to the applicable holder's continued service. Shares held of record by Dean Irwin & Melissa Burstein, as Trustees U/T/A June 12, 2017, of which the reporting person serves as co-trustee. 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 applicable holder's continued service. If the applicable holder's employment with the Company is terminated by the Company without cause, one-hundred percent (100%) of the shares subject to the option that have not vested shall immediately vest. CEO, Co-President, CTO, and Chairman of Board Exhibit 24 - Power of Attorney /s/ Andrew Jackson, as Attorney-in-Fact 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 Melissa Burstein, Andrew
Jackson, Daniel Sanchez-Linares, 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 September, 2018.
Signature:  /s/ Dean Irwin
Print Name:  Dean Irwin