Statement of Changes in Beneficial Ownership (4)
January 23 2020 - 4:07PM
Edgar (US Regulatory)
FORM 4
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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).
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
*
ANDREWS DEBORAH J |
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) Chief Financial Officer |
(Last)
(First)
(Middle)
25651 ATLANTIC OCEAN DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/21/2020 |
(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 | 1/21/2020 | | M | | 20000 | A | $11.00 | 52101 | D | |
Common Stock | 1/21/2020 | | M | | 20000 | A | $5.34 | 72101 | D | |
Common Stock | 1/21/2020 | | M | | 10000 | A | $15.54 | 82101 | D | |
Common Stock | 1/21/2020 | | M | | 15000 | A | $7.35 | 97101 | D | |
Common Stock | 1/21/2020 | | M | | 9000 | A | $7.36 | 106101 | D | |
Common Stock | 1/21/2020 | | M | | 4583 | A | $9.30 | 110684 | D | |
Common Stock | 1/21/2020 | | M | | 17360 | A | $15.25 | 128044 | D | |
Common Stock | 1/21/2020 | | M | | 7291 | A | $16.15 | 135335 | D | |
Common Stock | 1/21/2020 | | M | | 3370 | A | $29.80 | 138705 | D | |
Common Stock | 1/21/2020 | | S | | 106604 | D | $42.20 (1) | 32101 | 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 | $11.00 | 1/21/2020 | | M | | | 20000 | (2)(3) | 3/1/2022 | Common Stock | 20000 | $0.00 | 0 | D | |
Common Stock Options | $5.34 | 1/21/2020 | | M | | | 20000 | (2) | 3/3/2023 | Common Stock | 20000 | $0.00 | 0 | D | |
Common Stock Options | $15.54 | 1/21/2020 | | M | | | 10000 | (4) | 3/6/2024 | Common Stock | 10000 | $0.00 | 0 | D | |
Common Stock Options | $7.35 | 1/21/2020 | | M | | | 15000 | (5) | 4/6/2025 | Common Stock | 15000 | $0.00 | 0 | D | |
Common Stock Options | $7.36 | 1/21/2020 | | M | | | 9000 | (6) | 4/3/2026 | Common Stock | 9000 | $0.00 | 0 | D | |
Common Stock Options | $9.30 | 1/21/2020 | | M | | | 4583 | (7) | 3/20/2027 | Common Stock | 4583 | $0.00 | 139 | D | |
Common Stock Options | $15.25 | 1/21/2020 | | M | | | 17360 | (8) | 11/12/2027 | Common Stock | 17360 | $0.00 | 695 | D | |
Common Stock Options | $16.15 | 1/21/2020 | | M | | | 7291 | (9) | 3/14/2028 | Common Stock | 7291 | $0.00 | 347 | D | |
Common Stock Options | $29.80 | 1/21/2020 | | M | | | 3370 | (10) | 6/13/2021 | Common Stock | 3370 | $0.00 | 188 | 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 $41.86 to $42.53, inclusive. |
(2) | These stock options became exercisable in three equal annual installments on March 4, 2014, March 4, 2015, and March 4, 2016. |
(3) | These stock options became exercisable in three equal annual installments on March 2, 2013, March 2, 2014, and March 2, 2015. |
(4) | These stock options became exercisable in three equal annual installments on March 7, 2015, March 7, 2016, and March 7, 2017. |
(5) | These stock options became exercisable in three equal annual installments on April 7, 2016, April 7, 2017, and April 7, 2018. |
(6) | The options granted became exercisable as follows: 1/3 on 04/04/2017, and the remaining 2/3 of such options shall become 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 became exercisable on 04/04/2019. |
(7) | The options granted become exercisable as follows: 1/3 on 03/21/2018, and the remaining 2/3 of such options shall become 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 03/21/2020. |
(8) | The options granted become exercisable as follows: 1/3 on 11/13/2018, and the remaining 2/3 of such options shall become 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 11/13/2020. |
(9) | The options granted become exercisable as follows: 1/3 on 03/15/2019, and the remaining 2/3 of such options shall become 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 03/15/2021. |
(10) | The options granted become exercisable as follows: 1/3 on 06/14/2019, and the remaining 2/3 of such options shall become 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 06/14/2021. |
Remarks: This Form 4 reflects the exercise and sale by Ms. Andrews of Stock Options of the Company pursuant to instructions contained in a pre-established Rule 10b5-1 plan. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
ANDREWS DEBORAH J 25651 ATLANTIC OCEAN DRIVE LAKE FOREST, CA 92630 |
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| Chief Financial Officer |
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Signatures
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/s/ Samuel Gesten as attorney-in-fact for Deborah Andrews | | 1/23/2020 |
**Signature of Reporting Person | Date |
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