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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Common Stock Options | $ 6.83 | 09/13/2012 | A | 10,000 | 09/13/2013(2) | 09/13/2022 | Common Stock | 10,000 | $ 0 | 10,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SLACIK CHARLES P 1911 WALKER AVENUE MONROVIA, CA 91016 |
X |
/s/ Samuel Gesten as attorney-in-fact for Charles Slacik | 09/17/2012 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | These 2000 shares are restricted and subject to forfeiture, and vest in full on September 13, 2013, with vesting generally to accelerate in the event the grantee's service as director ends prior to that date. |
(2) | These 10000 stock options vest in full on September 13, 2013, with vesting generally to accelerate in the event the grantee's service as director ends prior to that date. |
Remarks: On September 13, 2012, STAAR's Board of Directors granted Mr. Charles Slacik an option to purchase 10,000 shares of common stock and also 2,000 restricted shares on election to the Board, which represents the standard director compensation for a director, pro-rated for the remaining portion of the 2012-2013 term |