FORM 5 |
UNITED STATES SECURITIES
AND EXCHANGE COMMISSION |
OMB APPROVAL |
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b). |
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 |
OMB Number:
3235-0362 Filed By |
1. Name and Address of Reporting Person* Farris, Michael R. |
2. Issuer Name and
Ticker or Trading Symbol |
6. Relationship of
Reporting Person(s) Chief Executive Officer |
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(Last) (First) (Middle) 3300 University Blvd., Suite 140 |
3. I.R.S. Identification
Number
|
4. Statement for Month/Year 12/31/02 |
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(Street) Winter Park, FL 32792 |
5. If Amendment, Date of Original (Month/Year) |
7. Individual
or Joint/Group Filing (Check Applicable Line) X Form filed by One Reporting Person Form filed by More than One Reporting Person |
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(City) (State) (Zip) |
Table I Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security |
2. Trans- |
2A. Deemed |
3. Trans- |
4. Securities Acquired
(A) or Disposed of (D) |
5. Amount of |
6. Owner- |
7. Nature of Indirect
|
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Amount |
(A) |
Price |
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Common Stock |
|
|
|
|
|
|
416000 |
D |
|
Reminder:
Report on a separate line for each class of securities beneficially owned
directly or indirectly. * If the form is filed by more than one reporting person, see Instruction 4(b)(v). 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 |
FORM 5 (continued) |
Table II -
Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Derivative
Security |
2. Conver- |
3. Trans- |
3A. Deemed Execution Date, if any (Month/ Day/ Year) |
4. Trans- |
5. Number of Derivative
Securities Acquired (A) or Disposed of (D) |
6. Date Exercisable |
7. Title and Amount
of Underlying Securities |
8. Price of Derivative
Security |
9. Number of |
10. Owner- |
11. Nature of Indirect
Beneficial Ownership |
|||
(A) |
(D) |
Date Exer-cisable |
Expira- |
Title |
Amount or Number
of |
|||||||||
Stock Option (right to buy) | 2.06 |
|
|
|
|
|
|
7/12/06 |
|
|
|
200000 |
D |
|
Stock Option (right to buy) | 5.00 |
|
|
|
|
|
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6/9/05 |
|
|
|
100000 |
D |
|
Stock Option (right to buy) | 5.00 |
|
|
|
|
|
|
12/31/06 |
|
|
|
107549 |
D |
|
Stock Option (right to buy) | 4.375 |
|
|
|
|
|
|
12/31/06 |
|
|
|
210000 |
D |
|
Stock Option (right to buy) | 4.7813 |
|
|
|
|
|
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6/30/03 |
|
|
|
40000 |
D |
|
Stock Option (right to buy) | 7.6875 |
|
|
|
|
|
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12/31/06 |
|
|
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131250 |
D |
|
Stock Option (right to buy) | 13.5 |
|
|
|
|
|
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12/31/06 |
|
|
|
58750 |
D |
|
Stock Option (right to buy) | 0.24 |
5/14/02 |
|
A |
100000 |
|
5/14/12 |
Common Stock |
100000 |
|
100000 |
D |
|
Explanation of Responses: (1) 20% on each of 6/10/02, 7/10/02, 8/10/02, 11/10/02 and 5/10/03 |
By:
/s/ Gregory L. Wilson Attorney-in-fact **Signature of Reporting Person |
02/13/03 Date |
**Intentional misstatements
or omissions of facts constitute Federal Criminal Violations. Note: File three
copies of this Form, one of which must be manually signed. 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 Number.
|
POWER OF ATTORNEY The undersigned individual hereby constitutes and appoints each of Michael R. Farris, Gregory L. Wilson and Albert J. Perry the undersigned's true and lawful attorney-in-fact and agent to execute any and all instruments and documents in the undersigned's name which such attorney-in-fact may deem necessary or advisable to comply with Section 16(a) of the Securities Exchange Act of 1934 and any rules of the Securities and Exchange Commission promulgated pursuant thereto, in connection with the undersigned's direct or indirect ownership of securities of LaserSight Incorporated, a Delaware corporation (such securities being referred to herein as "Securities"), including without limitation the power and authority to sign for the undersigned in the undersigned's name Forms ID, 3, 4, or 5 and any and all amendments thereto, to file the same, and to take any other action of any type whatsoever in connection with the foregoing which, in the judgment of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required of, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in their discretion. The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform all and every act and thing whatsoever requisite, necessary and proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as such attorney-in-fact might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or their substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted. The undersigned hereby acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file reports pursuant to Section 16 of the Exchange Act of 1934 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact. IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney this 26th day of September, 2002. Individual /s/ Michael R. Farris --------------------- [name of insider]