-----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, FTDwMgaLyrsayJTJT0etNVLZlWbvEuvojmhuqg71Z1IQZyc94kDDm/jKGWvSGiZv hHtS2NEk0vN0YKgUXgou3A== 0001181431-04-046999.txt : 20041006 0001181431-04-046999.hdr.sgml : 20041006 20041006183448 ACCESSION NUMBER: 0001181431-04-046999 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041004 FILED AS OF DATE: 20041006 DATE AS OF CHANGE: 20041006 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Farnworth James I CENTRAL INDEX KEY: 0001305413 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-11634 FILM NUMBER: 041069151 BUSINESS ADDRESS: BUSINESS PHONE: (626) 303-7902 MAIL ADDRESS: STREET 1: 1911 WALKER AVENUE CITY: MONROVIA STATE: CA ZIP: 91016 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: 0101 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 3 1 rrd54514.xml X0202 3 2004-10-04 0 0000718937 STAAR SURGICAL CO STAA 0001305413 Farnworth James I 1911 WALKER AVENUE MONROVIA CA 91016 0 1 0 0 VP Reg Affairs & Quality Common Stock Options 3.70 2005-10-04 2014-10-03 Common Stock 5000 D Common Stock Options 3.70 2006-10-04 2014-10-03 Common Stock 5000 D Common Stock Options 3.70 2007-10-04 2014-10-03 Common Stock 5000 D John Bily as Power of Attorney for James I. Farnworth 2004-10-06 -----END PRIVACY-ENHANCED MESSAGE-----