United States

Securities and Exchange Commission

Washington, D.C. 20549

 

 

Schedule 13G

(Rule 13d-102)

Information to be Included in Statements Filed Pursuant

to § 240.13d-1(b), (c) and (d) and Amendments Thereto Filed

Pursuant to § 240.13d-2

UNDER THE SECURITIES EXCHANGE ACT OF 1934

(Amendment No. )*

 

 

LENSAR, Inc.

(Name of Issuer)

Common Stock, par value $0.01

(Title of Class of Securities)

52634L108

(CUSIP Number)

December 31, 2020

(Date of Event Which Requires Filing of this Statement)

 

 

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

☐ Rule 13d-1(b)

☐ Rule 13d-1(c)

☒ Rule 13d-1(d)

 

*

The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).

 

 

 


CUSIP No. 52634L108    Schedule 13G    Page 1 of 4

 

  1   

Names of Reporting Persons

 

Nicholas T. Curtis

  2  

Check the Appropriate Box if a Member of a Group

(a)  ☐        (b)  ☐

 

  3  

SEC Use Only

 

  4  

Citizenship or Place of Organization

 

United States

Number of

Shares

Beneficially

Owned by

Each

Reporting

Person

With

     

Sole Voting Power

 

740,850

   6   

Shared Voting Power

 

0

   7   

Sole Dispositive Power

 

740,850

   8   

Shared Dispositive Power

 

0

  9  

Aggregate Amount Beneficially Owned by Each Reporting Person

 

740,850

10  

Check if the Aggregate Amount in Row (9) Excludes Certain Shares

 

Not Applicable

11  

Percent of Class Represented by Amount in Row 9

 

6.8%

12   

Type of Reporting Person

 

IN


CUSIP No. 52634L108    Schedule 13G    Page 2 of 4

 

ITEM 1.

(a) Name of Issuer:

LENSAR, Inc. (the “Issuer”).

(b) Address of Issuer’s Principal Executive Offices:

2800 Discovery Drive, Orlando, FL 32826.

 

ITEM 2.

(a) Name of Person Filing:

This statement is filed on behalf of Nicholas T. Curtis (the “Reporting Person”).

(b) Address of Principal Business Office:

The business address of the Reporting Person is c/o LENSAR, Inc., 2800 Discovery Drive, Orlando, FL 32826.

(c) Citizenship:

The Reporting Person is a citizen of the United States.

(d) Title of Class of Securities:

Common stock, par value $0.01 per share (“Common Stock”).

(e) CUSIP Number:

52634L108

 

ITEM 3.

Not applicable.

 

ITEM 4.

Ownership.

The ownership information below represents beneficial ownership of shares of Common Stock as of December 31, 2020, based upon 10,933,000 shares of Common Stock outstanding as of December 31, 2020.

(a) Amount beneficially owned:

The Reporting Person is the record holder of 740,850 shares of Common Stock, which includes 699,731 shares of restricted stock subject to time-based vesting conditions.


CUSIP No. 52634L108    Schedule 13G    Page 3 of 4

 

(b) Percent of class: 6.8%

(c) Number of shares as to which the person has:

 

  (i)

Sole power to vote or to direct the vote: 740,850

 

  (ii)

Shared power to vote or direct the vote: 0

 

  (iii)

Sole power to dispose or to direct the disposition of: 740,850

 

  (iv)

Shared power to dispose or to direct the disposition of: 0

 

ITEM 5.

Ownership of Five Percent or Less of a Class.

Not applicable.

 

ITEM 6.

Ownership of More than Five Percent on Behalf of Another Person.

Not applicable.

 

ITEM 7.

Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company.

Not applicable.

 

ITEM 8.

Identification and Classification of Members of the Group.

Not applicable.

 

ITEM 9.

Notice of Dissolution of Group.

Not applicable.

 

ITEM 10.

Certification.

Not applicable.


CUSIP No. 52634L108    Schedule 13G    Page 4 of 4

 

SIGNATURE

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

Date: February 11, 2021

 

Nicholas T. Curtis

/s/ Nicholas T. Curtis