0000899243-23-014591.txt : 20230606 0000899243-23-014591.hdr.sgml : 20230606 20230606171706 ACCESSION NUMBER: 0000899243-23-014591 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20230525 FILED AS OF DATE: 20230606 DATE AS OF CHANGE: 20230606 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ELLIS THOMAS B CENTRAL INDEX KEY: 0001283774 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39473 FILM NUMBER: 23996998 MAIL ADDRESS: STREET 1: 867 BOYLSTON STREET, 5TH FLOOR STREET 2: #1361 CITY: BOSTON STATE: MA ZIP: 02116 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: LENSAR, Inc. CENTRAL INDEX KEY: 0001320350 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 320125724 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2800 DISCOVERY DRIVE STREET 2: SUITE 100 CITY: ORLANDO STATE: FL ZIP: 32826 BUSINESS PHONE: 888-536-7271 MAIL ADDRESS: STREET 1: 2800 DISCOVERY DRIVE STREET 2: SUITE 100 CITY: ORLANDO STATE: FL ZIP: 32826 FORMER COMPANY: FORMER CONFORMED NAME: LensAR Inc DATE OF NAME CHANGE: 20070703 FORMER COMPANY: FORMER CONFORMED NAME: LaserSoft Vision Inc DATE OF NAME CHANGE: 20050310 4 1 doc4.xml FORM 4 SUBMISSION X0407 4 2023-05-25 0 0001320350 LENSAR, Inc. LNSR 0001283774 ELLIS THOMAS B C/O LENSAR, INC. 2800 DISCOVERY DRIVE ORLANDO FL 32826 1 0 1 0 0 Common Stock 2023-05-25 4 A 0 9288 0.00 A 9288 D Common Stock 1100592 I See Footnotes Stock Option (Right to Buy) 3.23 2023-05-25 4 A 0 94787 0.00 A 2033-05-25 Common Stock 94787 94787 D Stock Option (Right to Buy) 3.23 2023-05-25 4 A 0 33175 0.00 A 2033-05-25 Common Stock 33175 33175 D Consists of restricted stock units ("RSUs"). Each RSU represents a contingent right to receive one share of LENSAR, Inc. common stock. The RSUs vest in full on May 25, 2024, subject to the Reporting Person's continued service to the Issuer through the vesting date. The RSUs were granted in accordance with the Issuer's non-employee director compensation program as a component of the Reporting Person's annual compensation for service to the Issuer. The reported securities are directly held by North Run Capital, LP, and may be deemed to be indirectly beneficially owned by North Run Advisors, LLC as the general partner of North Run Capital, LP. The reported securities may also be deemed to be indirectly beneficially owned by the Reporting Person as a member of North Run Advisors, LLC. The Reporting Person disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission of beneficial ownership of the securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose. The option vests as to one-third of the award on May 25, 2024 and, as to the remaining amount of the award, in twenty-four (24) substantially equal monthly installments thereafter, subject to the Reporting Person's continued service to the Issuer through the applicable vesting date. The option was granted in accordance with the Issuer's non-employee director compensation program as initial compensation for service to the Issuer. The option vests in twelve (12) substantially equal monthly installments commencing June 25, 2023, subject to the Reporting Person's continued service to the Issuer through the applicable vesting date. The option was granted in accordance with the Issuer's non-employee director compensation program as a component of the Reporting Person's annual compensation for service to the Issuer. Exhibit 24 - Power of Attorney. /s/ Thomas R. Staab, II, attorney-in-fact 2023-06-06 EX-24 2 attachment1.htm EX-24 DOCUMENT
                                POWER OF ATTORNEY

        With respect to holdings of and transactions in securities issued by
LENSAR, Inc. (the "Company"), the undersigned hereby constitutes and appoints
the individuals named on Schedule A attached hereto and as may be amended from
time to time, or any of them signing singly, with full power of substitution
and resubstitution, to act as the undersigned's true and lawful attorney-in-
fact to:

        1.  prepare, execute in the undersigned's name and on the undersigned's
            behalf, and submit to the United States Securities and Exchange
            Commission (the "SEC") a Form ID, including amendments thereto, and
            any other documents necessary or appropriate to obtain and/or
            regenerate codes and passwords enabling the undersigned to make
            electronic filings with the SEC of reports required by Section
            16(a) of the Securities Exchange Act of 1934, as amended, or any
            rule or regulation of the SEC;

        2.  execute for and on behalf of the undersigned, Forms 3, 4, and 5 in
            accordance with Section 16 of the Securities Exchange Act of 1934,
            as amended, and the rules thereunder;

        3.  do and perform any and all acts for and on behalf of the
            undersigned which may be necessary or desirable to complete and
            execute any such Form 3, 4, or 5, complete and execute any
            amendment or amendments thereto, and timely file such form with the
            SEC and any stock exchange or similar authority; and

        4.  take any other action of any type whatsoever in connection with the
            foregoing which, in the opinion of such attorney-in-fact, may be of
            benefit to, in the best interest of, or legally required by, the
            undersigned, it being understood that the documents executed by
            such attorney-in-fact on behalf of the undersigned pursuant to this
            Power of Attorney shall be in such form and shall contain such
            terms and conditions as such attorney-in-fact may approve in such
            attorney-in-facts discretion.

        The undersigned hereby grants to each such attorney-in-fact full power
and authority to do and perform any and every act and thing whatsoever
requisite, necessary, or proper to be done in the exercise of any of the rights
and powers herein granted, as fully to all intents and purposes as the
undersigned might or could do if personally present, with full power of
substitution and resubstitution or revocation, hereby ratifying and confirming
all that such attorney-in-fact, or such attorneys-in-fact substitute or
substitutes, shall lawfully do or cause to be done by virtue of this Power of
Attorney and the rights and powers herein granted.

        The undersigned acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, are not assuming,
nor is any Company assuming, any of the undersigned's responsibilities to
comply with Section 16 of the Securities Exchange Act of 1934, as amended.

        This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.

        IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney
to be executed as of this 23rd day of May, 2023.

                                   By: /s/ Thomas B. Ellis
                                       -----------------------
                                   Name: Thomas B. Ellis


                                Schedule A

Individuals Appointed as Attorney-in-Fact with Full Power of Substitution and
Resubstitution

            1. Nicholas T. Curtis
            2. Thomas R. Staab, II