SEC Form 4 · accession 0001209191-17-054237
STAAR SURGICAL CO · STAA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Deborah J Andrews
Officer — Vice President · Other
Period of report
Sep 26, 2017
Accepted (ET)
Sep 28, 2017 · 3:13 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000718937
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Nov 13, 2017 | A | 12,500 | $0.00 | A | 16,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common Stock OptionsF2,F3 | — | Sep 26, 2017 | A | 25,000 | A | Sep 26, 2018 | Sep 25, 2027 | Common Stock | 25,000 | 25,000 | D |
Explanation of responses
- F1Award of 12,500 Restricted Stock Units of Common Stock (RSU), subject to forfeiture rights, which lapse as to 1/3 of the RSUs on 11/13/2018, 1/3 of the RSUs on 11/13/2019, and the remaining 1/3 of the RSUs on 11/13/2020.
- F2The 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.
- F3The exercise price of each option granted on 9/26/17 will be the fair market value of the Common Stock of the Corporation as of the close of business on 11/13/17.