Statement of Changes in Beneficial Ownership (4)
November 22 2019 - 5:00PM
Edgar (US Regulatory)
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 OF SECURITIES
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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
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1. Name and Address of Reporting Person
*
Hansen Graydon C. |
2. Issuer Name and Ticker or Trading Symbol
STAAR SURGICAL CO
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STAA
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Sr. VP, Global Operations |
(Last)
(First)
(Middle)
25651 ATLANTIC OCEAN DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/20/2019 |
(Street)
LAKE FOREST, CA 92630
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 11/20/2019 | | S | | 17083 | D | $35.02 (1) | 8334 (2) | D | |
Common Stock | 11/22/2019 | | M | | 9076 | A | $9.30 | 17410 | D | |
Common Stock | 11/22/2019 | | M | | 4862 | A | $7.52 | 22272 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 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 |
Common Stock Options | $9.30 | 11/22/2019 | | M | | 9076 | | 3/21/2018 (3) | 3/20/2027 | Common Stock | 9076 | $9.30 | 3881 | D | |
Common Stock Options | $7.52 | 11/22/2019 | | M | | 4862 | | 3/18/2017 (4) | 3/17/2026 | Common Stock | 4862 | $7.52 | 0 | D | |
Explanation of Responses: |
(1) | The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $35.00 to $35.05, inclusive. |
(2) | Reflects Restricted Stock Units of Common Stock (RSU), subject to forfeiture rights, which lapse as to 6,250 RSUs on March 21, 2020, and lapse as to 2,084 RSUs on November 13, 2020. |
(3) | The options granted became exercisable as follows: 1/3 on 3/21/2018 and the remaining 2/3 of such options became exercisable over the following 24 months in equal amounts on a monthly basis. In the event the options do not evenly divide into 24 months, the remaining balance of options granted shall become exercisable on 3/21/2020. |
(4) | The options granted became exercisable as follows: 1/3 on 3/18/2017 and 2/3 of such options became exercisable over the following 24 months in equal amounts on a monthly basis. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Hansen Graydon C. 25651 ATLANTIC OCEAN DRIVE LAKE FOREST, CA 92630 |
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| Sr. VP, Global Operations |
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Signatures
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/s/ Samuel Gesten as attorney-in-fact for Graydon Hansen | | 11/22/2019 |
**Signature of Reporting Person | Date |
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