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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 Warrants | $ 4 | 12/12/2013 | X | 700,000 (7) | (4) | 12/14/2013 | Common Stock | 700,000 | (5) | 0 | D (1) | ||||
Common Stock Warrants | $ 4 | 12/12/2013 | X | 0 | (4) | 12/14/2013 | Common Stock | 0 | (5) | 0 | I | Footnote (2) | |||
Common Stock Warrants | $ 4 | (4) | 06/01/2015 | Common Stock | 700,000 | 700,000 | D (1) | ||||||||
Common Stock Warrants | $ 4 | (4) | 06/01/2015 | Common Stock | 0 | 700,000 | I | Footnote (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BROADWOOD PARTNERS LP C/O BROADWOOD CAPITAL INC. 724 FIFTH AVENUE, 9TH FLOOR NEW YORK, NY 10019 |
X | |||
BRADSHER NEAL C C/O BROADWOOD CAPITAL INC. 724 FIFTH AVENUE, 9TH FLOOR NEW YORK, NY 10019 |
X | |||
BROADWOOD CAPITAL INC 724 FIFTH AVENUE, 9TH FLOOR NEW YORK, NY 10019 |
X |
Broadwood Partners, L.P., By: Broadwood Capital, Inc., By: /s/ Neal C. Bradsher, President | 12/16/2013 | |
**Signature of Reporting Person | Date | |
Neal C. Bradsher, /s/ Neal C. Bradsher | 12/16/2013 | |
**Signature of Reporting Person | Date | |
Broadwood Capital, Inc., By: /s/ Neal C. Bradsher, President | 12/16/2013 | |
**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 securities are owned by Broadwood Partners, L.P., which is a Reporting Person. |
(2) | The reported securities are directly owned by Broadwood Partners, L.P. and may be deemed beneficially owned by Broadwood Capital, Inc. as General Partner of Broadwood Partners, L.P. and Neal C. Bradsher as President of Broadwood Capital, Inc. The Reporting Persons disclaim beneficial ownership of the reported securities except to the extent of his or its pecuniary interest therein, and this report shall not be deemed an admission that such Reporting Person is the beneficial owner of the securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose. |
(3) | These securities are owned by Neal C. Bradsher, who is a Reporting Person. |
(4) | These warrants are currently exercisable with the underlying common shares issuable 61 days following the exercise date. |
(5) | These warrants were granted to Broadwood Partners, L.P. on December 14, 2007 pursuant to a warrant agreement between STAAR Surgical Company (the "Issuer") and Broadwood Partners, L.P. (the "Warrant Agreement") as additional consideration for Broadwood Partners, L.P. to enter into a senior promissory note between Broadwood Partners, L.P. and the Issuer on December 14, 2007. |
(6) | Reflects the cashless exercise of common stock warrants for 700,000 common shares by Broadwood Partners, L.P. Upon conversion and in accordance with the terms and provisions of the Warrant Agreement, Broadwood Partners, L.P. will receive 485,456 common shares issuable on February 11, 2014, with 214,544 common shares withheld by the Issuer to fund the cashless exercise of the warrants. |
(7) | Reflects 214,544 common shares withheld by the Issuer to fund the cashless exercise of the warrants. |