0001209191-23-058370.txt : 20231212 0001209191-23-058370.hdr.sgml : 20231212 20231212183123 ACCESSION NUMBER: 0001209191-23-058370 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231211 FILED AS OF DATE: 20231212 DATE AS OF CHANGE: 20231212 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SISITSKY NATHANIEL CENTRAL INDEX KEY: 0001225738 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-11634 FILM NUMBER: 231482447 MAIL ADDRESS: STREET 1: C/O CAREFUSION CORPORATION STREET 2: 3750 TORREY VIEW COURT CITY: SAN DIEGO STATE: CA ZIP: 92130 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 X0508 4 2023-12-11 0 0000718937 STAAR SURGICAL CO STAA 0001225738 SISITSKY NATHANIEL 25651 ATLANTIC OCEAN DRIVE LAKE FOREST CA 0 1 0 0 General Counsel 0 Common Stock 2023-12-11 4 A 0 21935 0.00 A 21935 D Common Stock Options 32.14 2023-12-11 4 A 0 39860 0.00 A 2024-12-11 2033-12-10 Common Stock 39860 39860 D Award of 21935 Restricted Stock Units of Common Stock (RSU), subject to forfeiture rights, which lapse as to 1/3 of the RSUs on 12/11/2024, 1/3 of the RSUs on 12/11/2025, and the remaining 1/3 of the RSUs on 12/11/2026. The options granted become exercisable as follows: 1/3 on 12/11/2024 and the remaining 2/3 of such options shall become exercisable over the following 24 months in equal amounts on a monthly basis. In the event the options do not evenly divide into 24 months, the remaining balance of options granted shall become exercisable on 12/11/2026. This Form 4 reflects the equity grant to Mr. Sisitsky related to his appointment as General Counsel. /s/ Nathaniel Sisitsky 2023-12-11