SEC Form 3 · accession 0001209191-18-052292
Ra Medical Systems, Inc. · VTAK
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owners
Martin Burstein
10% Owner
Period of report
Sep 26, 2018
Accepted (ET)
Sep 26, 2018 · 4:29 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001716621
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2,F3 | holding | — | — | — | 179,250 | D | ||
| Common StockF4 | holding | — | — | — | 1,604,500 | I | See Footnote | |
| Common StockF5 | holding | — | — | — | 350,000 | I | See Footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F6 | $28.94 | holding | — | — | — | — | Jun 4, 2028 | Common Stock | 42,000 | — | D |
| Stock Option (Right to Buy)F7 | $28.94 | holding | — | — | — | — | Jun 4, 2028 | Common Stock | 150,000 | — | D |
Explanation of responses
- F1Reported shares are represented by restricted stock units ("RSUs"), and each RSU is the economic equivalent of one share of Ra Medical Systems, Inc. common stock.
- F2148,860 of the RSUs shall vest as follows: 15% of the RSUs shall vest on the 10th day of the first month following the expiration of the Lock-Up Period (as defined in the award agreement) (the "LP"), 15% of the RSUs shall vest on the 10th day of the second month following the expiration of the LP, 15% of the RSUs shall vest on the 15th day of the fourth month following the expiration of the LP, 15% of the RSUs shall vest on the 15th day of the fifth month following the expiration of the LP, 15% of the RSUs shall vest on the 20th day of the seventh month following the expiration of the LP, 15% of the RSUs shall vest on the 20th day of the eighth month following the expiration of the LP, and 10% of the RSUs shall vest on the 25th day of the tenth month following the expiration of the LP, subject to the reporting persons continued service.
- F3The remaining 30,390 RSUs shall vest as follows: 33% of the RSUs shall vest on the 10th day of the third month following the expiration of the LP, 33% of the RSUs shall vest on the 15th day of the sixth month following the expiration of the LP, and 34% of the RSUs shall vest on the 20th day of the ninth month following the expiration of the LP, subject to the reporting person's continued service. In the event of a Change in Control (as defined in the Issuer's 2018 Stock Compensation Plan (the "Compensation Plan")), 100% of the RSUs shall immediately become fully vested, subject to the reporting person's continued service.
- F4Reported shares held of record by Martin Burstein Living Trust dated January 28, 2002, of which Martin Burstein is the sole trustee.
- F5Reported shares held of record by Karen Jorgensen Burstein Family Trust Dated November 10, 2000, of which Martin Burstein's spouse is the sole trustee.
- F6One thirty-sixth of the shares subject to the option vest each month over the thirty six months following January 1, 2017, on the same day of the month, subject to the reporting person's continued service. In the event of a Change in Control (as defined in the Compensation Plan), one hundred percent (100%) of the shares subject to the option shall immediately vest.
- F7One-third of the shares subject to the option shall vest on June 4, 2019, and one thirty-sixth of the shares subject to the option shall vest monthly thereafter, subject to the reporting person's continued service.
Remarks
Exhibit 24 - Powers of Attorney