0001654954-23-003617.txt : 20230327 0001654954-23-003617.hdr.sgml : 20230327 20230327172202 ACCESSION NUMBER: 0001654954-23-003617 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230109 FILED AS OF DATE: 20230327 DATE AS OF CHANGE: 20230327 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Meline Susanne CENTRAL INDEX KEY: 0001731684 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38677 FILM NUMBER: 23765479 MAIL ADDRESS: STREET 1: P.O. BOX 515381 STREET 2: #86506 CITY: LOS ANGELES STATE: CA ZIP: 90051 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 2023-01-09 0001716621 Ra Medical Systems, Inc. RMED 0001731684 Meline Susanne 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 2575 0 A 2575 I By Spouse Common Stock 36 D Common Stock 800 I See footnote Series X Convertible Preferred Stock 0 2023-01-09 4 A false 14.0560 0 A Common Stock 14056 14.056 I By Spouse Series X Convertible Preferred Stock 0 2023-03-23 4 C false 2.575 0 D Common Stock 11481 11.481 I By Spouse This the transaction was the result of the automatic conversion of shares of Series X Preferred upon receipt of stockholder approval. Securities are owned by Catalysis Partners ("CP"). The reporting person has an investment interest in CP through her IRA and, together with an immediate family member, owns a controlling interest in Francis Capital Management, LLC, which also has an investment interest in CP and serves as both its Managing Member and Investment Manager. The reporting person disclaims beneficial interest of these securities except to the extent of her pecuniary interest therein. Following stockholder approval of the conversion of Series X Convertible Preferred Stock into shares of Common Stock, each share of Series X Convertible Preferred Stock automatically converts into 1,000 shares of Common Stock, subject to certain limitations. On January 9, 2023, the Issuer, completed its acquisition of Catheter Precision, Inc., a privately-held Delaware corporation ("Catheter"), pursuant to an Amended and Restated Agreement and Plan of Merger (the "Merger"). In connection with the Merger, each share of Catheter common stock previously outstanding held by the reporting person now represents a number of shares of Series X Convertible Preferred Stock equal to approximately 0.6697, divided by one thousand (1,000). Series X Convertible Preferred Stock has no expiration date. /s/ Susanne Meline 2023-03-27