Sec Form 4 Filing - Burstein Martin @ Ra Medical Systems, Inc. - 2019-12-06

Insider filing report for Changes in Beneficial Ownership
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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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Burstein Martin
2. Issuer Name and Ticker or Trading Symbol
Ra Medical Systems, Inc. [ RMED]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
7393 MELODIA TER.
3. Date of Earliest Transaction (MM/DD/YY)
12/06/2019
(Street)
CARLSBAD, CA92011
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 08/05/2019 J V 77,016 ( 1 ) D $ 0 54,687 ( 2 ) D
Common Stock 08/05/2019 J V 77,016 ( 1 ) A $ 0 1,681,516 I See Footnote ( 3 )
Common Stock 12/06/2019 S 1,208 D $ 1.27 1,680,308 I See Footnote ( 3 )
Common Stock 12/09/2019 S 28,988 D $ 1.06 1,651,320 I See Footnote ( 3 )
Common Stock 12/10/2019 J V 54,687 ( 1 ) D $ 0 0 D
Common Stock 12/10/2019 J V 54,687 ( 1 ) A $ 0 1,706,007 I See Footnote ( 3 )
Common Stock 12/10/2019 S 46,820 D $ 1.01 1,659,187 I See Footnote ( 3 )
Common Stock 350,000 I See Footnote ( 4 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Burstein Martin
7393 MELODIA TER.
CARLSBAD, CA92011
X
Martin Burstein Living Trust Dated January 28, 2002
7393 MELODIA TER.
CARLSBAD, CA92011
X
Signatures
/s/ Martin Burstein 12/10/2019
Signature of Reporting Person Date
/s/ Martin Burstein for Martin Burstein Living Trust dated January 28, 2002 12/10/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Represents transfer of shares for no consideration from Martin Burstein to a family trust (the "Burstein Trust") of which Martin Burstein is the sole trustee.
( 2 )47,547 shares represented by restricted stock units held by Mr. Burstein were forfeited in connection with the termination of his consulting services to the issuer.
( 3 )Shares held of record by the Burstein Trust.
( 4 )Shares held of record by a family trust of which Mr. Burstein's spouse is the sole trustee.

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