0001209191-19-059371.txt : 20191205 0001209191-19-059371.hdr.sgml : 20191205 20191205182313 ACCESSION NUMBER: 0001209191-19-059371 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191203 FILED AS OF DATE: 20191205 DATE AS OF CHANGE: 20191205 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kraws Jeffrey J CENTRAL INDEX KEY: 0001380918 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38677 FILM NUMBER: 191271354 MAIL ADDRESS: STREET 1: 3985 RESEARCH PARK DRIVE CITY: ANN ARBOR STATE: MI ZIP: 48108 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 2019-12-03 0 0001716621 Ra Medical Systems, Inc. RMED 0001380918 Kraws Jeffrey J C/O RA MEDICAL SYSTEMS, INC. 2070 LAS PALMAS DRIVE CARLSBAD CA 92011 0 1 0 0 Co-President Common Stock 2019-12-04 4 F 0 38372 1.8219 D 114131 D Stock Option (Right to Buy) 1.22 2019-12-03 4 A 0 139052 0.00 A 2029-12-03 Common Stock 139052 139052 D Shares withheld by the issuer to satisfy the mandatory tax withholding requirement upon vesting of restricted stock units. This is not an open market sale of securities. Represents the weighted share price of an aggregate total of 38,372 shares withheld in the price range of $1.69 to $1.96 by the reporting person. The reporting person undertakes to provide upon request by the Commission staff, the issuer or a security holder of the issuer, full information regarding the number of shares withheld at each separate price. Of the reported shares 2,315 shares are represented by Restricted Stock Units. 1/36 of the total shares subject to the option shall vest every month after December 3, 2019, such that all shares shall be fully vested on December 3, 2022, subject to the Reporting Person continuing to be a "Service Provider" (as defined in the Company's 2018 Equity Incentive Plan) through each vesting date. /s/ Daniel Horwood, as Attorney-in-Fact 2019-12-05