0000899243-22-016099.txt : 20220502
0000899243-22-016099.hdr.sgml : 20220502
20220502134829
ACCESSION NUMBER: 0000899243-22-016099
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220428
FILED AS OF DATE: 20220502
DATE AS OF CHANGE: 20220502
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LORD JONATHAN T MD
CENTRAL INDEX KEY: 0001112980
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36385
FILM NUMBER: 22880934
MAIL ADDRESS:
STREET 1: 500 WEST MAIN ST.
CITY: LOUISVILLE
STATE: KY
ZIP: 40202
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: BIOLASE, INC
CENTRAL INDEX KEY: 0000811240
STANDARD INDUSTRIAL CLASSIFICATION: DENTAL EQUIPMENT & SUPPLIES [3843]
IRS NUMBER: 870442441
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 27042 TOWNE CENTRE DRIVE
STREET 2: SUITE 270
CITY: FOOTHILL RANCH
STATE: CA
ZIP: 92610
BUSINESS PHONE: 949-361-1200
MAIL ADDRESS:
STREET 1: 27042 TOWNE CENTRE DRIVE
STREET 2: SUITE 270
CITY: FOOTHILL RANCH
STATE: CA
ZIP: 92610
FORMER COMPANY:
FORMER CONFORMED NAME: BIOLASE TECHNOLOGY INC
DATE OF NAME CHANGE: 19941117
FORMER COMPANY:
FORMER CONFORMED NAME: LASER MEDICAL TECHNOLOGY INC
DATE OF NAME CHANGE: 19941117
FORMER COMPANY:
FORMER CONFORMED NAME: LASER ENDO TECHNIC CORP
DATE OF NAME CHANGE: 19920708
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2022-04-28
0
0000811240
BIOLASE, INC
BIOL
0001112980
LORD JONATHAN T MD
27042 TOWNE CENTRE DR.
SUITE 270
FOOTHILL RANCH
CA
92610
1
0
0
0
Series G Preferred Stock
2022-04-28
4
D
0
1395.41
D
0
D
On March 1, 2022, the Company's board of directors (the "Board") declared a dividend of one one-thousandth of a share of Series G Preferred Stock, par value $0.001 per share ("Preferred Stock"), for each outstanding share of Company Common Stock to stockholders of record at 5:00 p.m. Eastern Time on March 25, 2022 (the "Record Date"), in a transaction exempt from Section 16 under Rule 16a-9. The shares of Preferred Stock were distributed on March 25, 2022. As a result, the Reporting Person received 1,395.41 shares of Preferred Stock. The Preferred Stock is not convertible into, or exchangeable for, shares of any other class or series of stock or other securities of the Company.
On April 28, 2022, these shares of Preferred Stock were redeemed automatically in accordance with the certificate of designation for the shares of Preferred Stock. Each share of Preferred Stock was redeemed in consideration for the right to receive an amount equal to $0.01 in cash for each ten whole shares of Preferred Stock, with any remaining shares (of less than 10) receiving no cash.
/s/ Michael C. Carroll, attorney-in-fact for Jonathan T. Lord
2022-05-02