Statement of Changes in Beneficial Ownership (4)
November 17 2020 - 04:53PM
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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OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
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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 * Barnes Scott D |
2. Issuer Name and Ticker or Trading
Symbol STAAR SURGICAL CO [ STAA ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Chief Medical Officer |
(Last)
(First)
(Middle)
25651 ATLANTIC OCEAN DRIVE |
3. Date of Earliest Transaction (MM/DD/YYYY)
11/16/2020
|
(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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
11/16/2020 |
|
M |
|
5430 |
A |
$29.80 |
25820 |
D |
|
Common Stock |
11/16/2020 |
|
M |
|
17163 |
A |
$35.98 |
42983 |
D |
|
Common Stock |
11/16/2020 |
|
M |
|
22593 |
D |
$80.25 (1) |
20390 |
D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 |
$29.80 |
11/16/2020 |
|
M |
|
|
5430 |
6/14/2019 (2) |
6/13/2028 |
Common Stock |
5430 |
$0.00 |
1312 |
D |
|
Common Stock Options |
$35.98 |
11/16/2020 |
|
M |
|
|
17163 |
3/14/2020 (3) |
3/13/2029 |
Common Stock |
17163 |
$0.00 |
13731 |
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 $78.58 to $81.32,
inclusive. |
(2) |
The options granted become
exercisable as follows: 1/3 on 6/14/2019 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 6/14/2021. |
(3) |
The options granted become
exercisable as follows: 1/3 on 3/14/2020 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 3/14/2022. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Barnes Scott D
25651 ATLANTIC OCEAN DRIVE
LAKE FOREST, CA 92630 |
|
|
Chief Medical Officer |
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Signatures
|
/s/ Samuel Gesten as attorney-in-fact for Scott
Barnes |
|
11/17/2020 |
**Signature of Reporting
Person |
Date |