0000919574-13-006947.txt : 20131216 0000919574-13-006947.hdr.sgml : 20131216 20131216180025 ACCESSION NUMBER: 0000919574-13-006947 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20131212 FILED AS OF DATE: 20131216 DATE AS OF CHANGE: 20131216 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: 1228 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BROADWOOD CAPITAL INC CENTRAL INDEX KEY: 0001278387 STATE OF INCORPORATION: NY FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-11634 FILM NUMBER: 131279963 BUSINESS ADDRESS: STREET 1: 724 FIFTH AVENUE STREET 2: 9TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10019 BUSINESS PHONE: 212-508-5735 MAIL ADDRESS: STREET 1: 724 FIFTH AVENUE STREET 2: 9TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10019 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BRADSHER NEAL C CENTRAL INDEX KEY: 0001278388 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-11634 FILM NUMBER: 131279964 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BROADWOOD PARTNERS LP CENTRAL INDEX KEY: 0001278386 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-11634 FILM NUMBER: 131279965 BUSINESS ADDRESS: STREET 1: C/O BROADWOOD CAPITAL INC. STREET 2: 724 FIFTH AVENUE, 9TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10019 BUSINESS PHONE: 212-508-5735 MAIL ADDRESS: STREET 1: C/O BROADWOOD CAPITAL INC. STREET 2: 724 FIFTH AVENUE, 9TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10019 4 1 p1437538.xml BROADWOOD/STAAR X0306 4 2013-12-12 0 0000718937 STAAR SURGICAL CO STAA 0001278386 BROADWOOD PARTNERS LP C/O BROADWOOD CAPITAL INC. 724 FIFTH AVENUE, 9TH FLOOR NEW YORK NY 10019 0 0 1 0 0001278388 BRADSHER NEAL C C/O BROADWOOD CAPITAL INC. 724 FIFTH AVENUE, 9TH FLOOR NEW YORK NY 10019 0 0 1 0 0001278387 BROADWOOD CAPITAL INC 724 FIFTH AVENUE, 9TH FLOOR NEW YORK NY 10019 0 0 1 0 Common Stock 2013-12-12 4 X 0 700000 4.00 A 7101639 D Common Stock 2013-12-12 4 X 0 0 0 A 7101639 I Footnote Common Stock 2013-12-12 4 J 0 214544 13.05 D 6887095 D Common Stock 2013-12-12 4 J 0 0 0 D 6887095 I Footnote Common Stock 25900 D Common Stock Warrants 4.00 2013-12-12 4 X 0 700000 D 2013-12-14 Common Stock 700000 0 D Common Stock Warrants 4.00 2013-12-12 4 X 0 0 D 2013-12-14 Common Stock 0 0 I Footnote Common Stock Warrants 4.00 2015-06-01 Common Stock 700000 700000 D Common Stock Warrants 4.00 2015-06-01 Common Stock 0 700000 I Footnote These securities are owned by Broadwood Partners, L.P., which is a Reporting Person. 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. These securities are owned by Neal C. Bradsher, who is a Reporting Person. These warrants are currently exercisable with the underlying common shares issuable 61 days following the exercise date. 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. 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. Reflects 214,544 common shares withheld by the Issuer to fund the cashless exercise of the warrants. Broadwood Partners, L.P., By: Broadwood Capital, Inc., By: /s/ Neal C. Bradsher, President 2013-12-16 Neal C. Bradsher, /s/ Neal C. Bradsher 2013-12-16 Broadwood Capital, Inc., By: /s/ Neal C. Bradsher, President 2013-12-16