0001140361-15-045843.txt : 20151229 0001140361-15-045843.hdr.sgml : 20151229 20151229173306 ACCESSION NUMBER: 0001140361-15-045843 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151228 FILED AS OF DATE: 20151229 DATE AS OF CHANGE: 20151229 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: 4 CROMWELL CITY: IRVINE STATE: CA ZIP: 92618 BUSINESS PHONE: 949-361-1200 MAIL ADDRESS: STREET 1: 4 CROMWELL CITY: IRVINE STATE: CA ZIP: 92618 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jack W. Schuler Living Trust CENTRAL INDEX KEY: 0001661351 STATE OF INCORPORATION: IL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36385 FILM NUMBER: 151311915 BUSINESS ADDRESS: STREET 1: 100 NORTH FIELD DRIVE STREET 2: SUITE 360 CITY: LAKE FOREST STATE: IL ZIP: 60045 BUSINESS PHONE: 224-880-1210 MAIL ADDRESS: STREET 1: 100 NORTH FIELD DRIVE STREET 2: SUITE 360 CITY: LAKE FOREST STATE: IL ZIP: 60045 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SCHULER JACK W CENTRAL INDEX KEY: 0001021412 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36385 FILM NUMBER: 151311916 MAIL ADDRESS: STREET 1: 100 N. FIELD DRIVE STREET 2: SUITE 360 CITY: LAKE FOREST STATE: IL ZIP: 60045 4 1 doc1.xml FORM 4 X0306 4 2015-12-28 0 0000811240 BIOLASE, INC BIOL 0001021412 SCHULER JACK W 100 NORTH FIELD DRIVE SUITE 360 LAKE FOREST IL 60045 0 0 1 0 0001661351 Jack W. Schuler Living Trust 100 NORTH FIELD DRIVE SUITE 360 LAKE FOREST IL 60045 0 0 1 0 Common Stock 2015-12-28 4 P 0 18350 0.7887 A 6424374 I By Trust Common Stock 14800 I By spouse These shares are held by the Jack W. Schuler Living Trust (the "Trust"). Mr. Schuler serves as sole trustee to the Trust. The price reported in Column 4 is a weighted average price. These shares were purchased in multiple transactions at prices ranging from $0.775 to $0.79, inclusive. The reporting person undertakes to provide to the issuer, any security holder of the issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the ranges set forth in footnote (2) to this Form 4. /s/ Jack Schuler, self and as Trustee of the Jack W. Schuler Living Trust 2015-12-29