-----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, TS0z17BGqn++E1LKc8XxrJ/yEhiWoZ+fGPcHEDyoTB5CQ+hYyvXc/qEhshVs3Cfn KS3+MestReKtFrnFHiIwbA== 0000914317-99-000406.txt : 19990713 0000914317-99-000406.hdr.sgml : 19990713 ACCESSION NUMBER: 0000914317-99-000406 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990618 FILED AS OF DATE: 19990712 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: BIOLASE TECHNOLOGY INC CENTRAL INDEX KEY: 0000811240 STANDARD INDUSTRIAL CLASSIFICATION: DENTAL EQUIPMENT & SUPPLIES [3843] IRS NUMBER: 870442441 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-19627 FILM NUMBER: 99663014 BUSINESS ADDRESS: STREET 1: 981 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 BUSINESS PHONE: 7143611200 MAIL ADDRESS: STREET 1: 981 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 COMPANY DATA: COMPANY CONFORMED NAME: MANN ROBERT K CENTRAL INDEX KEY: 0001026701 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER IRS NUMBER: 061166053 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: C/O PERSPECTIVE ADVISORY CO STREET 2: 17 TRIPP ROAD CITY: WOODSTOCK STATE: CT ZIP: 06281 BUSINESS PHONE: 8003970722 MAIL ADDRESS: STREET 1: C/O PERSPECTIVE ADVISORY CO STREET 2: 17 TRIPP ROAD CITY: WOODSTOCK STATE: CT ZIP: 06281 4 1 FORM 4 ================================================================================ F O R M 4 ================================================================================ [ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ---------------------------------- OMB APPROVAL OMB Number 3235-0287 Expires: September 30, 1998 Estimated Average Burden hours per response . . . . . . 0.5 ---------------------------------- U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 ================================================================================ 1. Name and Address of Reporting Person* Mann, Robert K. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 17 Tripp Road - -------------------------------------------------------------------------------- (Street) Woodstock CT 06281 - -------------------------------------------------------------------------------- (City) (State) (Zip) ================================================================================ 2. Issuer Name and Ticker of Trading Symbol BioLase Technology, Inc. ================================================================================ 3. IRS or Social Security Number of Reporting Person (Voluntary) ================================================================================ 4. Statement for Month/Year June 1999 ================================================================================ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [X] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) ================================================================================ 7. Individual or Joint/Group filing (Check Appropriate Line) [X] Form filed by One Reporting Person [ ] Form filed by More Than One Reporting Person ================================================================================ *If the form is filed by more than one person, see Instruction 4(b)(v)
==================================================================================================================================== TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENFICIALLY OWNED ==================================================================================================================================== 1. Title of Security (Instr. 3) 2. Transaction Date 3. Transaction Code 4. Securities Acquired (A) (Month/Day/Year) (Instr. 8) or Disposed of (D) (Instr. 3, 4 and 5) ------------------- ------------------- -------------------------- (A) or Code V Amount (D) Price - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/18/99 S 13,700 D $2.77 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/21/99 S 4,482 D $2.75 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/22/99 S 8,182 D $2.75 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/23/99 S 4,000 D $2.75 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/24/99 S 3,000 D $2.75 - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 6/30/99 S 3,000 D $2.75 - ------------------------------------------------------------------------------------------------------------------------------------
==================================================================================================================================== TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENFICIALLY OWNED -- Continued ==================================================================================================================================== 1. Title of Security (Instr. 3) 5. Amount of Securities 6. Ownership Form: 7. Nature of Indirect Beneficially Owned Direct (D) or Beneficial at End of Month Indirect (I) Ownership (Instr. 3 and 4) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 18,182 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 18,182 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 18,182 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 18,182 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 18,182 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 18,182 D ====================================================================================================================================
==================================================================================================================================== TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTION, CONVERTIBLE SECURITIES) ==================================================================================================================================== 1. Title of Derivative Security 2. Conversion 3. Transaction Date 4. Transaction Code 5. Number of Derivative (Instr. 3) Or Exercise (Month/Day/Year) (Instr. 8) Securities Acquired (A) Price of or Disposed of (D) Derivative (Instr. 3, 4, and 5) Security ------------- ------------------- -------------------- --------------------------- Code V (A) (D) - ------------------------------------------------------------------------------------------------------------------------------------
==================================================================================================================================== TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTION, CONVERTIBLE SECURITIES) -- Continued ==================================================================================================================================== 1. Title of Derivative Security 6. Date 7. Title and 8. Price of (Instr. 3) Exercisable Amount of Derivavtive and Underlying Security Expiration Securities (Instr. 5) Date (Month/ (Instr. 3 Day/Year) and 4) -------------------- ---------------------------- -------------- Date Expira- Amount or Exer- tion Number cisable Date Title of Shares - ------------------------------------------------------------------------------------------------------------
==================================================================================================================================== TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTION, CONVERTIBLE SECURITIES) -- Continued ==================================================================================================================================== 1. Title of Derivative Security 9. Number of Derivative 10. Ownership Form of 11. Nature of Indirect (Instr. 3) Securities Beneficially Derivative Security: Beneficial Owned at End of Month Direct (D) or Ownership (Instr. 4) Indirect (I) (Instr. 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: /s/ Robert K. Mann 7-12-99 ----------------------------- ----------- **Signature of Reporting Person Date **Intentional misstatements or ommissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number. -----END PRIVACY-ENHANCED MESSAGE-----