Burstein Martin Form 4 Ra Medical Systems / Martin Burstein ownership change

SEC Form 4

FORM 4

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
or Section 30(h) of the Investment Company Act of 1940

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

1. Name and Address of Reporting Person^*

Burstein Martin

(Last) (First) (Middle)

7393 MELODIA TER.

(Street)

CARLSBAD CA 92011

(City) (State) (Zip)

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)

3. Date of Earliest Transaction (Month/Day/Year)
12/06/2019

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

	Form filed by One Reporting Person
X	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	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	$0.00	54,687(2)	D
Common Stock	08/05/2019		J	V	77,016(1)	A	$0.00	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	$0.00	0	D
Common Stock	12/10/2019		J	V	54,687(1)	A	$0.00	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 (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	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 (Month/Day/Year)		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: 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

1. Name and Address of Reporting Person^*

Burstein Martin

(Last) (First) (Middle)

7393 MELODIA TER.

(Street)

CARLSBAD CA 92011

(City) (State) (Zip)

1. Name and Address of Reporting Person^*

Martin Burstein Living Trust Dated January 28, 2002

(Last) (First) (Middle)

7393 MELODIA TER.

(Street)

CARLSBAD CA 92011

(City) (State) (Zip)

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.

	/s/ Martin Burstein	12/10/2019
	/s/ Martin Burstein for Martin Burstein Living Trust dated January 28, 2002	12/10/2019
	** Signature of Reporting Person	Date
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).
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