Initial Statement of Beneficial Ownership (3)

Date : 07/10/2019 @ 11:23PM
Source : Edgar (US Regulatory)
Stock : STAAR Surgical Company (STAA)
Quote : 35.67  0.96 (2.77%) @ 9:30PM
After Hours
Last Trade
Last $ 35.67 ◊ 0.00 (0.00%)

Initial Statement of Beneficial Ownership (3)

FORM 3
        
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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OMB Number: 3235-0104
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

Hayashida Jon K.

2. Date of Event Requiring Statement (MM/DD/YYYY)
6/27/2019 

3. Issuer Name and Ticker or Trading Symbol

STAAR SURGICAL CO [STAA]

(Last)        (First)        (Middle)

25651 ATLANTIC OCEAN DRIVE

4. Relationship of Reporting Person(s) to Issuer (Check all applicable)

_____ Director                            _____ 10% Owner
___ X ___ Officer (give title below)          _____ Other (specify below)
VP, Global Clinical, Medical /

(Street)

LAKE FOREST, CA 92630       

(City)              (State)              (Zip)
5. If Amendment, Date Original Filed (MM/DD/YYYY)

 

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

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


Table I - Non-Derivative Securities Beneficially Owned
1.Title of Security
(Instr. 4)
2. Amount of Securities Beneficially Owned
(Instr. 4)
3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
4. Nature of Indirect Beneficial Ownership
(Instr. 5)
Common Stock   21323   (1) D    

Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 4)
2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
4. Conversion or Exercise Price of Derivative Security 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
6. Nature of Indirect Beneficial Ownership
(Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Common Stock Options   (2) 7/27/2016   7/26/2025   Common Stock Options   50000   $8.64   D    
Common Stock Options   (3) 3/18/2017   3/17/2026   Common Stock Options   25000   $7.52   D    
Common Stock Options   (4) 3/21/2018   3/20/2027   Common Stock Options   37500   $9.30   D    
Common Stock Options   (5) 3/15/2019   3/14/2028   Common Stock Options   25000   $16.15   D    
Common Stock Options   (6) 6/14/2019   6/13/2028   Common Stock Options   13484   $29.80   D    
Common Stock Options   (7) 3/14/2020   3/13/2029   Common Stock Options   28026   $35.98   D    

Explanation of Responses:
(1)  Includes 6,250 Restricted Stock Units of Common Stock (RSU), subject to forfeiture rights, which lapse on March 21, 2020.
(2)  The options granted became exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (7/27/2015) and the remaining 2/3 vested in thirds on the following two anniversaries of the grant date, subject to continuous employment.
(3)  The options granted became exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (3/18/2016) and the remaining 2/3 of such options became exercisable over the following 24 months in equal amounts on a monthly basis, subject to continuous employment.
(4)  The options granted become exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (3/21/2017) and the remaining 2/3 of such options become exercisable over the following 24 months in equal amounts on a monthly basis, subject to continuous employment.
(5)  The options granted become exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (3/15/2018) and the remaining 2/3 of such options become exercisable over the following 24 months in equal amounts on a monthly basis, subject to continuous employment.
(6)  The options granted become exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (6/14/2018) and the remaining 2/3 of such options become exercisable over the following 24 months in equal amounts on a monthly basis, subject to continuous employment.
(7)  The options granted become exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (3/14/2019) and the remaining 2/3 of such options become exercisable over the following 24 months in equal amounts on a monthly basis, subject to continuous employment.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director 10% Owner Officer Other
Hayashida Jon K.
25651 ATLANTIC OCEAN DRIVE
LAKE FOREST, CA 92630


VP, Global Clinical, Medical

Signatures
/s/ Samuel Gesten as attorney-in-fact for Jon Hayashida 7/10/2019
** 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 5(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 control number.

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