DRS 1 filename1.htm DRS

CONFIDENTIAL TREATMENT REQUESTED BY LENSAR, INC.

PURSUANT TO 17 C.F.R. SECTION 200.83

 

As confidentially submitted to the Securities and Exchange Commission on June 19, 2020

File No.                    

 

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

Form 10

 

 

GENERAL FORM FOR REGISTRATION OF SECURITIES

PURSUANT TO SECTION 12 (b) OR (g) OF

THE SECURITIES EXCHANGE ACT OF 1934

 

 

LENSAR, INC.

(Exact name of registrant as specified in its charter)

 

 

 

Delaware   320125724

(State or other jurisdiction of

incorporation or organization)

  

(I.R.S. Employer

Identification No.)

 

2800 Discovery Drive,

Orlando, Florida

   32826
(Address of principal executive offices)   (Zip Code)

Registrant’s telephone number, including area code: (888) 536-7271

Securities to be registered pursuant to Section 12(b) of the Act:

 

Title of each class to be so registered

  

Name of each exchange on which each class is to be registered

Common stock,

par value $0.01 per share

  

Securities to be registered pursuant to Section 12(g) of the Act: None

 

 

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

 

Large accelerated filer   ☐    Accelerated filer   ☐
Non-accelerated filer   ☒    Smaller reporting company   ☒
     Emerging growth company   ☒

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.  ☐

 

 

 

 

CONFIDENTIAL TREATMENT REQUESTED BY LENSAR, INC.

PURSUANT TO 17 C.F.R. SECTION 200.83

 

LENSAR, INC.

INFORMATION REQUIRED IN REGISTRATION STATEMENT

CROSS-REFERENCE SHEET BETWEEN INFORMATION STATEMENT AND ITEMS OF FORM 10

Certain information required to be included in this Form 10 is incorporated by reference to specifically-identified portions of the body of the information statement filed herewith as Exhibit 99.1. None of the information contained in the information statement shall be incorporated by reference herein or deemed to be a part hereof unless such information is specifically incorporated by reference.

Item 1. Business.

The information required by this item is contained under the sections of the information statement entitled “Information Statement Summary,” “Risk Factors,” “Special Note Regarding Forward-Looking Statements,” “The Spin-Off,” “Management’s Discussion and Analysis of Financial Condition and Results of Operations,” “Business,” “Certain Relationships and Related Party Transactions” and “Where You Can Find More Information.” Those sections are incorporated herein by reference.

Item 1A. Risk Factors.

The information required by this item is contained under the sections of the information statement entitled “Risk Factors” and “Special Note Regarding Forward-Looking Statements.” Those sections are incorporated herein by reference.

Item 2. Financial Information

The information required by this item is contained under the sections of the information statement entitled “Summary Historical Financial Data,” and “Management’s Discussion and Analysis of Financial Condition and Results of Operations.” Those sections are incorporated herein by reference.

Item 3. Properties.

The information required by this item is contained under the section of the information statement entitled “Business—Facilities.” That section is incorporated herein by reference.

Item 4. Security Ownership of Certain Beneficial Owners and Management.

The information required by this item is contained under the section of the information statement entitled “Security Ownership of Certain Beneficial Owners and Management.” That section is incorporated herein by reference.

Item 5. Directors and Executive Officers.

The information required by this item is contained under the sections of the information statement entitled “Management.” Those sections are incorporated herein by reference.

Item 6. Executive Compensation.

The information required by this item is contained under the sections of the information statement entitled “Executive Compensation.” Those sections are incorporated herein by reference.

Item 7. Certain Relationships and Related Transactions.

The information required by this item is contained under the sections of the information statement entitled “Management” and “Certain Relationships and Related Party Transactions.” Those sections are incorporated herein by reference.

 

CONFIDENTIAL TREATMENT REQUESTED BY LENSAR, INC.

PURSUANT TO 17 C.F.R. SECTION 200.83

 

Item 8. Legal Proceedings.

The information required by this item is contained under the section of the information statement entitled “Business—Legal Proceedings.” That section is incorporated herein by reference.

Item 9. Market Price of, and Dividends on, the Registrant’s Common Equity and Related Stockholder Matters.

The information required by this item is contained under the section of the information statement entitled “Information Statement Summary,” “The Spin-Off,” “Dividend Policy” and “Description of LENSAR Capital Stock.” Those sections are incorporated herein by reference.

Item 10. Recent Sales of Unregistered Securities.

The information required by this item is contained under the section of the information statement entitled “Recent Sales of Unregistered Securities.” That section is incorporated herein by reference.

Item 11. Description of Registrant’s Securities to be Registered.

The information required by this item is contained under the section of the information statement entitled “The Spin-Off” and “Description of LENSAR Capital Stock.” Those sections are incorporated herein by reference.

Item 12. Indemnification of Directors and Officers.

The information required by this item is contained under the section of the information statement entitled “Certain Relationships and Related Party Transactions—Indemnification Agreements” and “Indemnification and Limitation of Liability of Directors and Officer.” Those sections are incorporated herein by reference.

Item 13. Financial Statements and Supplementary Data.

The information required by this item is contained under the section of the information statement entitled “Index to Financial Statements” (and the financial statements and related notes referenced therein). That section is incorporated herein by reference.

Item 14. Changes in and Disagreements with Accountants on Accounting and Financial Disclosure.

Not applicable.

Item 15. Financial Statements and Exhibits.

 

  (a)

Financial Statements

The information required by this item is contained under the section of the information statement entitled “Index to Financial Statements” (and the financial statements and related noted referenced therein). That section is incorporated herein by reference.

 

CONFIDENTIAL TREATMENT REQUESTED BY LENSAR, INC.

PURSUANT TO 17 C.F.R. SECTION 200.83

 

  (b)

Exhibits

See below.

The following documents are filed as exhibits hereto:

 

Exhibit
Number

   

Exhibit Description

  2.1*    Form of Separation and Distribution Agreement between PDL BioPharma, Inc. and LENSAR, Inc.
  3.1*    Form of Amended and Restated Certificate of Incorporation of LENSAR, Inc.
  3.2*    Form of Amended and Restated Bylaws of LENSAR, Inc.
  4.1*    Form of Certificate of Common Stock
10.1*    Form of Transition Services Agreement between PDL BioPharma, Inc. and LENSAR, Inc.
10.2*    Form of Tax Matters Agreement between PDL BioPharma, Inc. and LENSAR, Inc.
10.3#*    2017 Phantom Stock Plan
10.4#*    2020 Equity Incentive Plan
10.5#*    2020 Employee Stock Purchase Plan
10.6#*    Form of Employment Agreement, by and between LENSAR, Inc. and Nicholas Curtis
10.7#*    Form of Employment Agreement, by and between LENSAR, Inc. and Alan Connaughton
10.8#*    Form of Employment Agreement, by and between LENSAR, Inc. and Thomas Staab, II
10.9*    Form of Indemnification Agreement between LENSAR, Inc. and its directors and officers
10.10*    Exclusive License Agreement, dated September 23, 2019, by and among Doug Patton, Ophthalmic Synergies, LLC and LENSAR, Inc.
99.1    Preliminary Information Statement of LENSAR, Inc., subject to completion, dated                 

 

*

To be filed by amendment.

#

Indicates management contract or compensatory plan.

 

CONFIDENTIAL TREATMENT REQUESTED BY LENSAR, INC.

PURSUANT TO 17 C.F.R. SECTION 200.83

 

SIGNATURES

Pursuant to the requirements of Section 12 of the Securities Exchange Act of 1934, the registrant has caused this registration statement to be signed on its behalf by the undersigned, thereunto duly authorized.

 

LENSAR, Inc.
By:  

 

  Name:   Nicholas Curtis
  Title:   Chief Executive Officer

Date: