0001209191-19-042894.txt : 20190722 0001209191-19-042894.hdr.sgml : 20190722 20190722173218 ACCESSION NUMBER: 0001209191-19-042894 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190718 FILED AS OF DATE: 20190722 DATE AS OF CHANGE: 20190722 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: 19966462 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: 19966463 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 2019-07-18 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 2019-07-18 4 S 0 14302 2.9314 D 199510 D Common Stock 2019-07-18 4 S 0 8584 2.9314 D 119854 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. Of the reported shares 136,455 shares are represented by Restricted Stock Units. Of the reported shares 81,873 shares are represented by Restricted Stock Units. 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 /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 2019-07-22