-----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, MnAUGdpup+x4jwtKVMgRb/JdF9rvxj/F8GRZoqQPdzbFCjbaDRbkZHb888zocODE d8DJK6gKRihFy0gbf5vMDg== 0001181431-05-004108.txt : 20050121 0001181431-05-004108.hdr.sgml : 20050121 20050121123321 ACCESSION NUMBER: 0001181431-05-004108 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050119 FILED AS OF DATE: 20050121 DATE AS OF CHANGE: 20050121 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SCHLOTTERBECK DAVID L CENTRAL INDEX KEY: 0001214967 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-11634 FILM NUMBER: 05540744 MAIL ADDRESS: STREET 1: 10221 WATERIDGE CIRCLE CITY: SAN DIEGO STATE: CA ZIP: 92121 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 rrd65357.xml SCHLOTTERBECK FORM 3 01_21_05 X0202 3 2005-01-19 0 0000718937 STAAR SURGICAL CO STAA 0001214967 SCHLOTTERBECK DAVID L C/O STAAR SURGICAL COMPANY 1911 WALKER AVENUE MONROVIA CA 91016 1 0 0 0 Common Stock Options 5.97 2005-01-19 2015-01-18 Common Stock 20000 D Common Stock Options 5.97 2006-01-19 2015-01-18 Common Stock 20000 D Common Stock Options 5.97 2007-01-19 2015-01-18 Common Stock 20000 D Deborah Andrews as Power of Attorney for David L. Schlotterbeck 2005-01-21 -----END PRIVACY-ENHANCED MESSAGE-----