Amended Statement of Ownership (sc 13g/a)
March 12 2020 - 6:10AM
Edgar (US Regulatory)
UNITED
STATES
SECURITIES AND EXCHANGE COMMISSION
Washington,
D.C. 20549
SCHEDULE
13G
Under
the Securities Exchange Act of 1934
(Amendment
No. 1)
RA
MEDICAL SYSTEMS, INC.
(Name
of Issuer)
Common
Stock, $0.0001 par value per share
(Title
of Class of Securities)
74933X104
(CUSIP
Number)
December
31, 2019
(Date
of Event which Requires Filing of this Statement)
Check
the appropriate box to designate the rule pursuant to which this Schedule is filed:
[ ]
Rule 13d-1(b)
[ ]
Rule 13d-1(c)
[X]
Rule 13d-1(d)
*
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The
remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to
the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided
in a prior cover page.
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|
|
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The
information required on the remainder of this cover page shall not be deemed to be “filed” for the purpose of
Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section
of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
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CUSIP
No.: 74933X104
1
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Names
of reporting persons
Martin
Burstein
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2
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Check
the appropriate box if a member of a group (see instructions)
(a)
[ ] (b) [ ]
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3
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SEC
use only
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4
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Citizenship
or place of organization
United
States of America
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Number
of
shares
beneficially
owned
by
each
reporting
person
with
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5
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Sole
Voting Power
0
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6
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Shared
Voting Power
1,956,203(1)
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7
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Sole
Dispositive Power
0
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8
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Shared
Dispositive Power
1,956,203(1)
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9
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Aggregate
amount beneficially owned by each reporting person
1,956,203(1)
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10
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Check
if the aggregate amount in Row (9) excludes certain shares (see instructions) [ ]
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11
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Percent
of class represented by amount in Row (9)
14.6%(2)
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12
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Type
of reporting person (See Instructions):
IN
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(1)
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Consists
of 1,606,203 shares of common stock held of record by a family trust of which the reporting person is the sole trustee
and 350,000 shares of common stock held of record by a family trust of which the reporting person’s spouse is the sole
trustee.
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(2)
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This
percentage is based on 13,407,995 shares of the issuer’s common stock outstanding as of November 20, 2019, as reported
in the issuer’s periodic report for the quarterly period ended September 30, 2019.
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CUSIP
No.: 74933X104
Item
1(a).
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Name
of issuer:
Ra
Medical Systems, Inc.
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Item
1(b).
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Address
of issuer’s principal executive offices:
2070
Las Palmas Drive
Carlsbad,
California 92011
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Item
2(a).
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Name
of person filing:
Martin
Burstein
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Item
2(b).
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Address
of principal business office or, if none, residence:
7393
Melodia Ter.
Carlsbad, California 92011
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Item
2(c).
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Citizenship:
United
States
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Item
2(d).
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Title
of Class of Securities:
Common
Stock, $0.0001 par value per share
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Item
2(e).
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CUSIP
Number:
74933X104
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Item
3.
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If
this statement is filed pursuant to §§240.13d-1(b), or 240.13d-2(b) or (c),
check whether the person filing is a:
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(a)
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[ ]
Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o).
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(b)
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[ ]
Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c).
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(c)
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[ ]
Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c).
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(d)
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[ ]
Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8).
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(e)
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[ ]
An investment adviser in accordance with §240.13d-1(b)(1)(ii)(E);
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(f)
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[ ]
An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F);
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(g)
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[ ]
A parent holding company or control person in accordance with §240.13d-1(b)(1)(ii)(G);
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(h)
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[ ]
A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);
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(i)
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[ ]
A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company
Act of 1940 (15 U.S.C. 80a-3);
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(j)
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[ ]
A non-U.S. institution in accordance with §240.13d-1(b)(1)(ii)(J);
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(k)
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[ ]
Group, in accordance with Rule 13d-1(b)(1)(ii)(K). If filing as a non-U.S. institution in accordance with §240.13d-1(b)(1)(ii)(J),
please specify the type of institution: _______________________
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Item
4.
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Ownership.
The
information required by Items 4(a) - (c) is set forth in Rows 5 - 11 of the cover page of this statement and is incorporated
herein by reference.
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Item
5.
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Ownership
of Five Percent or Less of a Class.
If
this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the
beneficial owner of more than five percent of the class of securities, check the following: [ ]
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Item
6.
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Ownership
of More than Five Percent on Behalf of Another Person.
Not
applicable
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Item
7.
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Identification
and Classification of the Subsidiary Which Acquired the Security Being Reported on By
the Parent Holding Company or Control Person:
Not
applicable
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Item
8.
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Identification
and Classification of Members of the Group:
Not
applicable
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Item
9.
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Notice
of Dissolution of Group:
Not
applicable
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Item
10.
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Certifications.
Not
applicable
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SIGNATURE
After
reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this Statement is true,
complete and correct.
Dated:
March 11, 2020
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/s/
Martin Burstein
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Martin
Burstein
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