-----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, Kr275C7T+PxTRFadyRl4wHiIAXSpU1vy/Y63uGeAyFQf30NiOySDgU+fE+mbiajp akODxmhhPbBsel9lyLMsbQ== 0001019687-05-001981.txt : 20050718 0001019687-05-001981.hdr.sgml : 20050718 20050718165122 ACCESSION NUMBER: 0001019687-05-001981 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031212 FILED AS OF DATE: 20050718 DATE AS OF CHANGE: 20050718 ISSUER: 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 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 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 FORMER COMPANY: FORMER CONFORMED NAME: PAMPLONA CAPITAL CORP DATE OF NAME CHANGE: 19911104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jones Jeffrey W CENTRAL INDEX KEY: 0001333418 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19627 FILM NUMBER: 05959861 BUSINESS ADDRESS: BUSINESS PHONE: 949-361-1200 MAIL ADDRESS: STREET 1: 981 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 4 1 edgar.xml PRIMARY DOCUMENT X0202 4 2003-12-12 0000811240 BIOLASE TECHNOLOGY INC BLTI 0001333418 Jones Jeffrey W 981 CALLE AMANECER SAN CLEMENTE, CA 92673 1 1 0 0 Former President & CEO Stock Option (right to buy) 14.01 2003-12-12 4 A 0 200000 0 A 2013-12-12 Common Stock 200000 200000 D The option vests in 24 equal monthly installments of 8,333 each beginning one month after the date of grant. /s/ Jeffrey W. Jones 2005-07-05 -----END PRIVACY-ENHANCED MESSAGE-----