0001181431-11-047375.txt : 20110829 0001181431-11-047375.hdr.sgml : 20110829 20110829203414 ACCESSION NUMBER: 0001181431-11-047375 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110825 FILED AS OF DATE: 20110829 DATE AS OF CHANGE: 20110829 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: STAAR SURGICAL CO CENTRAL INDEX KEY: 0000718937 STANDARD INDUSTRIAL CLASSIFICATION: OPHTHALMIC GOODS [3851] IRS NUMBER: 953797439 STATE OF INCORPORATION: DE FISCAL YEAR END: 0101 BUSINESS ADDRESS: STREET 1: 1911 WALKER AVE CITY: MONROVIA STATE: CA ZIP: 91016 BUSINESS PHONE: 6263037902 MAIL ADDRESS: STREET 1: 1911 WALKER AVE CITY: MONROVIA STATE: CA ZIP: 91016 FORMER COMPANY: FORMER CONFORMED NAME: STAAR SURGICAL COMPANY DATE OF NAME CHANGE: 19920703 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FAGEN DONALD L CENTRAL INDEX KEY: 0001206975 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-11634 FILM NUMBER: 111064083 MAIL ADDRESS: STREET 1: 3400 CENTRAL AVENUE CITY: SANTA CLARA STATE: CA ZIP: 95051 4 1 rrd320901.xml FORM 4 D FAGEN X0304 4 2011-08-25 0 0000718937 STAAR SURGICAL CO STAA 0001206975 FAGEN DONALD L 1911 WALKER AVE MONROVIA CA 91016 0 1 0 0 V.P. Sales for N. America Common Stock 2011-08-25 4 M 0 16666 3.17 A 27166 D Common Stock 2011-08-25 4 S 0 2219 7.37 D 24947 D Common Stock 2011-08-25 4 S 0 700 7.38 D 24247 D Common Stock 2011-08-25 4 S 0 1000 7.39 D 23247 D Common Stock 2011-08-25 4 S 0 2200 7.40 D 21047 D Common Stock 2011-08-25 4 S 0 400 7.41 D 20647 D Common Stock 2011-08-25 4 S 0 1000 7.42 D 19647 D Common Stock 2011-08-25 4 S 0 600 7.43 D 19047 D Common Stock 2011-08-25 4 S 0 2600 7.44 D 16447 D Common Stock 2011-08-25 4 S 0 900 7.45 D 15547 D Common Stock 2011-08-25 4 S 0 600 7.47 D 14947 D Common Stock 2011-08-25 4 S 0 300 7.48 D 14647 D Common Stock 2011-08-25 4 S 0 1700 7.51 D 12947 D Common Stock 2011-08-25 4 S 0 1847 7.55 D 11100 D Common Stock 2011-08-25 4 S 0 600 7.56 D 10500 D Common Stock Options 3.17 2011-08-25 4 M 0 16666 0 D 2021-03-14 Common Stock 16666 33334 D Following all reported transactions, Mr. Fagen's total beneficial ownership (as defined in Rule 13d-3 under the Exchange Act) is 10,500 shares of Common Stock, which consists of 3,000 restricted shares and 7,500 performance accelerated restricted shares. He also holds 53,334 unvested stock options. The 50,000 options originally granted first become exercisable as follows: 16,666 shares on 1/13/11, 16,667 shares on 1/13/12 and 16,667 shares on 1/13/13. This Statement on Form 4 reports Mr. Fagen's exercise of options to purchase 16,666 shares of STAAR Surgical Company common stock and sale of the purchased shares on August 25, 2011. /s/Charles Kaufman as attorney-in-fact for Donald L. Fagen 2011-08-29