Statement of Changes in Beneficial Ownership (4)
November 26 2019 - 4:35PM
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
*
Moore John C |
2. Issuer Name and Ticker or Trading Symbol
STAAR SURGICAL CO
[
STAA
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
25651 ATLANTIC OCEAN DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/25/2019 |
(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 | 11/25/2019 | | M | | 20000 | A | $4.73 | 65035 | D | |
Common Stock | 11/25/2019 | | M | | 8613 | D | $38.54 (1) | 56422 | D | |
Common Stock | | | | | | | | 92296 | I | By Family Trust (2) |
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 | $4.73 | 11/25/2019 | | M | | | 20000 | 5/19/2011 | 5/18/2020 | Common Stock | 20000 | $0.00 | 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 $38.50 to $38.61, inclusive. |
(2) | Shares allocated to reporting person's family trust. |
Remarks: This Form 4 reflects the exercise of stock options set to expire in May 2020. Mr. Moore sold shares to pay the strike price and to cover the tax obligations resulting from the stock option exercise. Mr. Moore elected to hold the remaining shares from the stock option exercise. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Moore John C 25651 ATLANTIC OCEAN DRIVE LAKE FOREST, CA 92630 | X |
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Signatures
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/s/ Samuel Gesten as attorney-in-fact for Mr. John C. Moore | | 11/26/2019 |
**Signature of Reporting Person | Date |
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