0001209191-19-029699.txt : 20190514 0001209191-19-029699.hdr.sgml : 20190514 20190514170205 ACCESSION NUMBER: 0001209191-19-029699 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 3 CONFORMED PERIOD OF REPORT: 20190513 FILED AS OF DATE: 20190514 DATE AS OF CHANGE: 20190514 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Irwin Dean CENTRAL INDEX KEY: 0001746687 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38677 FILM NUMBER: 19823653 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: Dean Irwin & Melissa Burstein, as Trustees U/T/A June 12, 2017 CENTRAL INDEX KEY: 0001748379 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38677 FILM NUMBER: 19823654 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: 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 2019-05-13 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 0001748379 Dean Irwin & Melissa Burstein, as Trustees U/T/A June 12, 2017 C/O RA MEDICAL SYSTEMS, INC. 2070 LAS PALMAS DRIVE CARLSBAD CA 92011 0 0 1 0 Common Stock 2019-05-13 4 S 0 13736 3.82 D 221212 D Common Stock 2019-05-13 4 S 0 8246 3.82 D 132838 I By Spouse Common Stock 2803852 I See Footnote Represents the number of shares required to be sold by the Reporting Person to cover tax withholding obligations in connection with the vesting of restricted stock units. This sale is mandated by the Reporting Person's award agreement to require the satisfaction of tax withholding obligations to be funded by a "sell to cover" transaction and does not represent a discretionary trade by the Reporting Person. The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $3.7989 to $3.8291 per share. The Reporting Person undertakes to provide to the issuer, any security holder of the issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. The reported price in Column 4 is a weighted average sale price. These shares were sold in multiple transactions at prices ranging from $3.7952 to $3.8254 per share. The Reporting Person undertakes to provide to the issuer, any security holder of the issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote. Shares held of record by Dean Irwin & Melissa Burstein, as Trustees U/T/A June 12, 2017, of which Dean Irwin serves as co-trustee. CEO, Co-President, CTO, and Chairman of Board Exhibit 24 - Powers of Attorney /s/ Daniel Horwood, as Attorney-in-Fact, on behalf of Dean Irwin and Dean Irwin & Melissa Burstein, as Trustees U/T/A June 12, 2017 2019-05-14 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 Andrew Jackson, Tiah Reppas,
Daniel Horwood, Zachary Myers, and Kathryn Fortin, 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, as a Section 16 reporting person of the Company, hereby revokes
any and all prior powers of attorney previously signed by the undersigned.
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 9th day of April, 2019.

Signature:  /s/ Dean Irwin
Print Name:  Dean Irwin
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 Andrew Jackson, Tiah Reppas,
Daniel Horwood, Zachary Myers, and Kathryn Fortin, 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, as a Section 16 reporting person of the Company, hereby revokes
any and all prior powers of attorney previously signed by the undersigned.
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 23rd day of April, 2019.
Dean Irwin and Melissa Burstein, as Trustees U/T/A June 12, 2017

Signature:/s/ Dean Irwin
Print Name: Dean Irwin, Co-Trustee


Signature: /s/ Melissa Burstein
Print Name: Melissa Burstein, Co-Trustee