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Andrews Deborah J – ‘4’ for 1/21/20 re: Staar Surgical Co.

On:  Thursday, 1/23/20, at 4:06pm ET   ·   For:  1/21/20   ·   Accession #:  1209191-20-4627   ·   File #:  0-11634

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  As Of               Filer                 Filing    For·On·As Docs:Size             Issuer                      Filing Agent

 1/23/20  Andrews Deborah J                 4                      1:28K  Staar Surgical Co.                DONNELLEY FIN… File16/FA

Statement of Changes in Beneficial Ownership of Securities by an Insider   —   Form 4   —   SEA’34
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 4           Form 4 Submission -- doc4.xml/3.6                   HTML      3K 




        

This ‘4’ Document is an XML Data File that may be rendered in various formats:

  Form 4    –   Plain Text   –  SEC Website  –  EDGAR System  –    XML Data    –  <?xml?> File
 

 
SEC Info rendering:  Form 4 Submission
 
FORM 4UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number:3235-0287
Estimated average burden
hours per response:0.5
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
ANDREWS DEBORAH J

(Last)(First)(Middle)
25651 ATLANTIC OCEAN DRIVE

(Street)
LAKE FORESTCA92630

(City)(State)(Zip)
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
XOfficer (give title below) Other (specify below)
Chief Financial Officer
3. Date of Earliest Transaction (Month/Day/Year)
1/21/20
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
XForm 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. Transaction Date (Month/Day/Year)2A. Deemed Execution Date, if any (Month/Day/Year)3. Transaction 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)
CodeVAmount(A) or (D)Price
Common Stock 1/21/20M 20,000A$1152,101D
Common Stock 1/21/20M 20,000A$5.3472,101D
Common Stock 1/21/20M 10,000A$15.5482,101D
Common Stock 1/21/20M 15,000A$7.3597,101D
Common Stock 1/21/20M 9,000A$7.36106,101D
Common Stock 1/21/20M 4,583A$9.3110,684D
Common Stock 1/21/20M 17,360A$15.25128,044D
Common Stock 1/21/20M 7,291A$16.15135,335D
Common Stock 1/21/20M 3,370A$29.8138,705D
Common Stock 1/21/20S 106,604D$42.2 (1)32,101D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year)3A. Deemed Execution Date, if any (Month/Day/Year)4. Transaction 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 (Month/Day/Year)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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
CodeV(A)(D)Date ExercisableExpiration DateTitleAmount or Number of Shares
Common Stock Options$11 1/21/20M 20,000 (2) (3) 3/1/22Common Stock20,000$0.000D
Common Stock Options$5.34 1/21/20M 20,000 (2) 3/3/23Common Stock20,000$0.000D
Common Stock Options$15.54 1/21/20M 10,000 (4) 3/6/24Common Stock10,000$0.000D
Common Stock Options$7.35 1/21/20M 15,000 (5) 4/6/25Common Stock15,000$0.000D
Common Stock Options$7.36 1/21/20M 9,000 (6) 4/3/26Common Stock9,000$0.000D
Common Stock Options$9.3 1/21/20M 4,583 (7) 3/20/27Common Stock4,583$0.00139D
Common Stock Options$15.25 1/21/20M 17,360 (8) 11/12/27Common Stock17,360$0.00695D
Common Stock Options$16.15 1/21/20M 7,291 (9) 3/14/28Common Stock7,291$0.00347D
Common Stock Options$29.8 1/21/20M 3,370 (10) 6/13/21Common Stock3,370$0.00188D
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 4/4/17, 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 4/4/19.
(7)  The options granted become exercisable as follows: 1/3 on 3/21/18, 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 3/21/20.
(8)  The options granted become exercisable as follows: 1/3 on 11/13/18, 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 11/13/20.
(9)  The options granted become exercisable as follows: 1/3 on 3/15/19, 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 3/15/21.
(10)  The options granted become exercisable as follows: 1/3 on 6/14/19, 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 6/14/21.
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.
/s/ Samuel Gesten as attorney-in-fact for Deborah Andrews 1/23/20
** Signature of Reporting PersonDate
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.
____________
Transaction Codes:
    M    Exercise or conversion of derivative security exempted pursuant to Rule 16b-3.
    S    Open market or private sale of non-derivative or derivative security.

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