SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 03/16/2022 | 3. Issuer Name and Ticker or Trading Symbol STAAR SURGICAL CO [ STAA ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 20,850(1) | D | |
Common Stock | 502 | I | By spouse. |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Common Stock Options | 03/07/2023(2) | 03/07/2032 | Commmon Stock | 12,547 | 74.8 | D | |
Common Stock Options | 03/12/2022(3) | 03/12/2031 | Common Stock | 4,879 | 90.38 | D | |
Common Stock Options | 03/20/2021(4) | 03/20/2030 | Common Stock | 14,629 | 27.53 | D | |
Common Stock Options | 03/14/2022(5) | 03/14/2029 | Common Stock | 24,284 | 35.98 | D | |
Common Stock Options | 06/14/2021(5) | 06/14/2028 | Common Stock | 2,368 | 29.8 | D | |
Common Stock Options | 03/15/2021(5) | 03/14/2028 | Common Stock | 10,015 | 16.15 | D | |
Common Stock Options | 03/21/2020(5) | 03/21/2027 | Common Stock | 10,000 | 9.3 | D | |
Common Stock Options | 04/04/2019(5) | 04/04/2026 | Common Stock | 10,000 | 7.36 | D |
Explanation of Responses: |
1. Of these, 9,917 are restricted shares subject to forfeiture rights, of which 2,010 will vest on 03/07/2023, 769 will vest on 03/12/2023, 2,346 will vest on 03/20/2023, 2,011 will vest on 03/07/2024, 770 will vest on 03/12/2024, and 2,011 will vest on 03/07/2025. |
2. The options become exercisable as follows: 1/3 on 3/7/2023 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 3/7/2025. |
3. The options become exercisable as follows: 1/3 on 3/12/2022 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 3/12/2024. |
4. The options become exercisable as follows: 1/3 on 3/20/2021, 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 3/20/2023. |
5. All options became exercisable on or before the stated date. |
/s/Samuel Gesten as Attorney-in-Fact for Robert Studholme | 07/05/2022 | |
** Signature of Reporting Person | Date | |
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 5 (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. |