0001209191-19-041750.txt : 20190710 0001209191-19-041750.hdr.sgml : 20190710 20190710192215 ACCESSION NUMBER: 0001209191-19-041750 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20190627 FILED AS OF DATE: 20190710 DATE AS OF CHANGE: 20190710 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hayashida Jon K. CENTRAL INDEX KEY: 0001781825 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-11634 FILM NUMBER: 19950207 MAIL ADDRESS: STREET 1: 25651 ATLANTIC OCEAN DRIVE CITY: LAKE FOREST STATE: CA ZIP: 92630 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: 0103 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 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2019-06-27 0 0000718937 STAAR SURGICAL CO STAA 0001781825 Hayashida Jon K. 25651 ATLANTIC OCEAN DRIVE LAKE FOREST CA 92630 0 1 0 0 VP, Global Clinical, Medical Common Stock 21323 D Common Stock Options 8.64 2016-07-27 2025-07-26 Common Stock Options 50000 D Common Stock Options 7.52 2017-03-18 2026-03-17 Common Stock Options 25000 D Common Stock Options 9.30 2018-03-21 2027-03-20 Common Stock Options 37500 D Common Stock Options 16.15 2019-03-15 2028-03-14 Common Stock Options 25000 D Common Stock Options 29.80 2019-06-14 2028-06-13 Common Stock Options 13484 D Common Stock Options 35.98 2020-03-14 2029-03-13 Common Stock Options 28026 D Includes 6,250 Restricted Stock Units of Common Stock (RSU), subject to forfeiture rights, which lapse on March 21, 2020. The options granted became exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (7/27/2015) and the remaining 2/3 vested in thirds on the following two anniversaries of the grant date, subject to continuous employment. The options granted became exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (3/18/2016) and the remaining 2/3 of such options became exercisable over the following 24 months in equal amounts on a monthly basis, subject to continuous employment. The options granted become exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (3/21/2017) and the remaining 2/3 of such options become exercisable over the following 24 months in equal amounts on a monthly basis, subject to continuous employment. The options granted become exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (3/15/2018) and the remaining 2/3 of such options become exercisable over the following 24 months in equal amounts on a monthly basis, subject to continuous employment. The options granted become exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (6/14/2018) and the remaining 2/3 of such options become exercisable over the following 24 months in equal amounts on a monthly basis, subject to continuous employment. The options granted become exercisable as follows: 1/3 upon completion of 12 months continuous employment from the date of grant (3/14/2019) and the remaining 2/3 of such options become exercisable over the following 24 months in equal amounts on a monthly basis, subject to continuous employment. /s/ Samuel Gesten as attorney-in-fact for Jon Hayashida 2019-07-10 EX-24.3_864703 2 poa.txt POA DOCUMENT LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING OBLIGATIONS Know all by these presents, that the undersigned's hereby makes, constitutes and appoints Samuel Gesten and Deborah Andrews as the undersigned's true and lawful attorneys-in-fact, with full power and authority as hereinafter described on behalf of and in the name, place and stead of the undersigned to: (1) prepare, execute, acknowledge, deliver and file Forms 3, 4, and 5 (including any amendments thereto) with respect to the securities of STAAR Surgical Company, a Delaware corporation (the "Company"), with the United States Securities and Exchange Commission, any national securities exchanges and the Company, as considered necessary or advisable under Section 16(a) of the Securities Exchange Act of 1934 and the rules and regulations promulgated thereunder, as amended from time to time (the "Exchange Act"); (2) seek or obtain, as the undersigned's representative and on the undersigned's behalf, information on transactions in the Company's securities from any third party, including brokers, employee benefit plan administrators and trustees, and the undersigned hereby authorizes any such person to release any such information to the undersigned and approves and ratifies any such release of information; and (3) perform any and all other acts which in the discretion of such attorneys-in-fact are necessary or desirable for and on behalf of the undersigned in connection with the foregoing. The undersigned acknowledges that: (1) this Power of Attorney authorizes, but does not require, such attorneys-in-fact to act in their discretion on information provided to such attorney-in-fact without independent verification of such information; (2) any documents prepared and/or executed by such attorneys-in-fact on behalf of the undersigned pursuant to this Power of Attorney will be in such form and will contain such information and disclosure as such attorneys-in-fact, in his or her discretion, deems necessary or desirable; (3) neither the Company nor such attornesy-in-fact assumes (i) any liability for the undersigned's responsibility to comply with the requirement of the Exchange Act, (ii) any liability of the undersigned for any failure to comply with such requirements, or (iii) any obligation or liability of the undersigned for profit disgorgement under Section 16(b) of the Exchange Act; and (4) this Power of Attorney does not relieve the undersigned from responsibility for compliance with the undersigned's obligations under the Exchange Act, including without limitation the reporting requirements under Section 16 of the Exchange Act. The undersigned hereby gives and grants the foregoing attorneys-in-fact full power and authority to do and perform all and every act and thing whatsoever requisite, necessary or appropriate to be done in and about the foregoing matters as fully to all intents and purposes as the undersigned might or could do if present, hereby ratifying all that such attorney-in-fact of, for and on behalf of the undersigned, shall lawfully do or cause to be done by virtue of this Limited Power of Attorney. This Power of Attorney shall remain in full force and effect until revoked by the undersigned in a signed writing delivered to such attorney-in-fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 1st day of July, 2019. /s/ Jon Hayashida _________________________________ Signature Jon Hayashida _________________________________ Print Name