-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, QJTUdiWewMw+DH/EVwxN77jU0ao7uRDk7OMln99KvHkCNiVWTBZp1Ov8/4x9R1Pz Jh4uq8nJ9zZHpixeO2ySQQ== 0001235950-04-000001.txt : 20040407 0001235950-04-000001.hdr.sgml : 20040407 20040407162445 ACCESSION NUMBER: 0001235950-04-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040407 FILED AS OF DATE: 20040407 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BOUTACOFF THEODORE A CENTRAL INDEX KEY: 0001235950 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27598 FILM NUMBER: 04722586 BUSINESS ADDRESS: STREET 1: 1212 TERRA BELLA AVENUE CITY: MOUNTAIN VIEW STATE: CA ZIP: 94043 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: IRIDEX CORP CENTRAL INDEX KEY: 0001006045 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 770210467 STATE OF INCORPORATION: DE FISCAL YEAR END: 0102 BUSINESS ADDRESS: STREET 1: 1212 TERRA BELLA AVE CITY: MOUNTAIN VIEW STATE: CA ZIP: 95043-1824 BUSINESS PHONE: 6509404700 MAIL ADDRESS: STREET 1: 1212 TERRA BELLA AVENUE CITY: MOUNTAIN VIEW STATE: CA ZIP: 95043-1824 4 1 primary_doc.xml PRIMARY DOCUMENT X0201 4 2004-04-07 0 0001006045 IRIDEX CORP IRIX 0001235950 BOUTACOFF THEODORE A 1 1 0 0 President and CEO Common Stock 2004-04-06 4 M 0 10000 1 A 204945 D Incentive Stock Option (Right to Buy) 1 2004-04-06 4 M 0 10000 0 D 1994-10-31 2004-04-14 Common Stock 10000 0 D This option was granted pursuant to IRIDEX Corporation's incentive stock option plan and is exempt pursuant to Rule 16b-3. The shares are subject to vesting according to the following schedule: 6/48th of the total number of shares shall be exercisable on October 13, 1994 and 1/48th of shares shall be exercisable on the last day of each calendar month commencing November 30, 1994. /s Theodore A. Boutacoff 2004-04-06 -----END PRIVACY-ENHANCED MESSAGE-----