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