Statement of Changes in Beneficial Ownership (4)
April 01 2020 - 5:57PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
McGuire Jonathan Will |
2. Issuer Name and Ticker or Trading Symbol
Ra Medical Systems, Inc.
[
RMED
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Executive Officer |
(Last)
(First)
(Middle)
C/O RA MEDICAL SYSTEMS, INC., 2070 LAS PALMAS DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/30/2020 |
(Street)
CARLSBAD, CA 92011
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 3/30/2020 | | A | | 125000 (1) | A | $0.00 | 125000 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (right to buy) | $1.02 | 3/30/2020 | | A | | 450000 | | (2) | 3/30/2030 | Common Stock | 450000 | $0.00 | 450000 | D | |
Explanation of Responses: |
(1) | The reported shares were issued as a restricted stock award ("RSA"). The RSA shall vest and become non-forfeitable in equal semi-annual installments over four years following May 20, 2020, subject to the reporting person continuing to be a Service Provider (as defined in the Company's 2020 Inducement Equity Incentive Plan) through each vesting date (for the avoidance of doubt, the first vesting date for the RSA will be November 20, 2020, upon which date 1/8 of the shares covered by the RSA may vest). |
(2) | The option shall vest in equal monthly installments over four years following March 30, 2020, subject to the reporting person continuing to be a Service Provider (as defined in the Company's 2020 Inducement Equity Incentive Plan) to the Company through each vesting date, so that the option is fully vested on March 30, 2024. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
McGuire Jonathan Will C/O RA MEDICAL SYSTEMS, INC. 2070 LAS PALMAS DRIVE CARLSBAD, CA 92011 | X |
| Chief Executive Officer |
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Signatures
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/s/ Daniel Horwood, as Attorney-in-Fact | | 4/1/2020 |
**Signature of Reporting Person | Date |
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