0001209191-23-038169.txt : 20230616 0001209191-23-038169.hdr.sgml : 20230616 20230616203532 ACCESSION NUMBER: 0001209191-23-038169 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230615 FILED AS OF DATE: 20230616 DATE AS OF CHANGE: 20230616 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Yu K Peony CENTRAL INDEX KEY: 0001621328 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-11634 FILM NUMBER: 231023027 MAIL ADDRESS: STREET 1: C/O FIBROGEN, INC. STREET 2: 409 ILLINOIS ST., CITY: SAN FRANCISCO STATE: CA ZIP: 94158 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: 1230 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 4 1 doc4.xml FORM 4 SUBMISSION X0407 4 2023-06-15 0 0000718937 STAAR SURGICAL CO STAA 0001621328 Yu K Peony 25651 ATLANTIC OCEAN DRIVE LAKE FOREST CA 1 0 0 0 0 Common Stock 2023-06-15 4 M 0 1709 0.00 A 2786 D Common Stock Options 52.67 2023-06-15 4 M 0 3127 0.00 A 2024-06-15 2034-06-14 Common Stock 3127 3127 D The restrictions on the 1709 restricted shares of common stock lapse on the earlier of June 15, 2023 or the Corporation's 2024 Annual Meeting, subject to Dr. Yu's continued service through that date. The options vest on the earlier of June 15, 2024 or the Corporation's 2024 Annual Shareholders Meeting, subject to her continued service through the vesting date. /s/ Samuel Gesten as attorney-in-fact for Dr. K. Peony Yu. 2023-06-16