0001654954-23-003615.txt : 20230327 0001654954-23-003615.hdr.sgml : 20230327 20230327172022 ACCESSION NUMBER: 0001654954-23-003615 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230323 FILED AS OF DATE: 20230327 DATE AS OF CHANGE: 20230327 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Caruso James Joseph CENTRAL INDEX KEY: 0001397215 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38677 FILM NUMBER: 23765466 MAIL ADDRESS: STREET 1: 28 FIRST AVE CITY: SEASIDE PARK STATE: NJ ZIP: 08752 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 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1670 HIGHWAY 160 WEST STREET 2: SUITE 205 CITY: FORT MILL STATE: SC ZIP: 29708 BUSINESS PHONE: 973-691-2000 MAIL ADDRESS: STREET 1: 1670 HIGHWAY 160 WEST STREET 2: SUITE 205 CITY: FORT MILL STATE: SC ZIP: 29708 4 1 section16.xml PRIMARY DOCUMENT X0407 4 2023-03-23 0001716621 Ra Medical Systems, Inc. RMED 0001397215 Caruso James Joseph C/O RA MEDICAL SYSTEMS, INC. 1670 HIGHWAY 160 WEST, SUITE 205 FORT MILL SC 29708 true false false false Common Stock 2023-03-23 4 C false 1779 0 A 1779 D Series X Convertible Preferred Stock 0 2023-03-23 4 C false 1.779 0 D Common Stock 7932 7.932 D This the transaction was the result of the automatic conversion of shares of Series X Preferred upon receipt of stockholder approval. Each share of preferred stock will automatically convert into 1000 shares of common stock on or after July 9, 2024, if the Company satisfies the initial listing standards of a national securities exchange or has been delisted from the NYSE American. Series X Convertible Preferred Stock has no expiration date. /s/ James Joseph Caruso 2023-03-24