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