# EDGAR Filing Document

**Accession Number:** 0001279803
**File Stem:** 0001209191-23-003033
**Filing Date:** 2023-1
**Character Count:** 7082
**Document Hash:** 024ea417a8b59cff12e81edc0ebffde7
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001209191-23-003033.hdr.sgml**: 20230111

**ACCESSION NUMBER**: 0001209191-23-003033

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230109

**FILED AS OF DATE**: 20230111

**DATE AS OF CHANGE**: 20230111

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** JENKINS DAVID A
- **CENTRAL INDEX KEY:** 0001279803

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-38677
- **FILM NUMBER:** 23524260

**MAIL ADDRESS:**
- **STREET 1:** P.O. BOX 682838
- **CITY:** PARK CITY
- **STATE:** UT
- **ZIP:** 84068
**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:** 5857 OWENS DRIVE, SUITE 300
- **CITY:** CARLSBAD
- **STATE:** CA
- **ZIP:** 92009
- **BUSINESS PHONE:** (760) 804-1648

**MAIL ADDRESS:**
- **STREET 1:** 5857 OWENS DRIVE, SUITE 300
- **CITY:** CARLSBAD
- **STATE:** CA
- **ZIP:** 92009

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>JENKINS DAVID A<br><sub>(Last) (First) (Middle)</sub><br>C/O RA MEDICAL SYSTEMS, INC.<br>5857 OWENS DRIVE, SUITE 300<br><sub>(Street)</sub><br>CARLSBAD, CA 92009<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-01-09 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_Executive Chairman of Board_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Ra Medical Systems, Inc. [ RMED ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Series X Convertible Preferred Stock | <sup>(1)</sup> | 2023-01-09 |  | A<sup>(2)</sup> |  | 2569.936 |  | <sup>(1)</sup> | <sup>(3)</sup> | Common Stock | 2569936 | <sup>(1)</sup> | 2569.936 | D |  |
| Series X Convertible Preferred Stock | <sup>(1)</sup> | 2023-01-09 |  | A<sup>(2)</sup> |  | 20.955 |  | <sup>(1)</sup> | <sup>(3)</sup> | Common Stock | 20955 | <sup>(1)</sup> | 20.955 | I | See footnote<sup>(4)</sup> |
| Series X Convertible Preferred Stock | <sup>(1)</sup> | 2023-01-09 |  | A<sup>(2)</sup> |  | 6570.243 |  | <sup>(1)</sup> | <sup>(3)</sup> | Common Stock | 6570243 | <sup>(1)</sup> | 6570.243 | I | See footnote<sup>(5)</sup> |

---

### Footnotes:

(1) 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.

(2) 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).

(3) Series X Convertible Preferred Stock has no expiration date

(4) Shares held by charitable remainder unitrust of which the reporting person's spouse is the trustee.

(5) Shares held by a partnership of which the reporting person is the managing member of the managing partner.

**Signature:** /s/ Will McGuire, as Attorney-in-Fact  
**Date:** 2023-01-11

### Remarks:

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**