# EDGAR Filing Document

**Accession Number:** 0001716621
**File Stem:** 0001654954-23-003617
**Filing Date:** 2023-3
**Character Count:** 7392
**Document Hash:** 8a3e406586288879a4a788da698b1e5f
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001654954-23-003617.hdr.sgml**: 20230327

**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

### 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>Meline Susanne<br><sub>(Last) (First) (Middle)</sub><br>C/O RA MEDICAL SYSTEMS, INC.<br>1670 HIGHWAY 160 WEST, SUITE 205<br><sub>(Street)</sub><br>FORT MILL, SC 29708<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>[ ] Officer (give title below) [ ] Other (specify below)<br>_ _ |
| **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 |
| Common Stock | 2023-03-23 |  | C<sup>(1)</sup> |  | 2575 | A | $0 | 2575 | I | By Spouse |
| Common Stock |  |  |  |  |  |  |  | 36 | D |  |
| Common Stock |  |  |  |  |  |  |  | 800 | I | See footnote<sup>(2)</sup> |

---

## 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 | 0<sup>(3)</sup> | 2023-01-09 |  | A<sup>(4)</sup> |  | 14.0560 |  | <sup>(3)</sup> | <sup>(5)</sup> | Common Stock | 14056 | $0 | 14.056 | I | By Spouse |
| Series X Convertible Preferred Stock | $0 | 2023-03-23 |  | C |  |  | 2.575 | <sup>(1)</sup> | <sup>(5)</sup> | Common Stock | 11481 | $0 | 11.481 | I | By Spouse |

---

### Footnotes:

(1) This the transaction was the result of the automatic conversion of shares of Series X Preferred upon receipt of stockholder approval.

(2) 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.

(3) 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.

(4) 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).

(5) Series X Convertible Preferred Stock has no expiration date.

**Signature:** /s/ Susanne Meline  
**Date:** 2023-03-27

### 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.**