0001209191-11-029264.txt : 20110518 0001209191-11-029264.hdr.sgml : 20110518 20110518131903 ACCESSION NUMBER: 0001209191-11-029264 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110518 FILED AS OF DATE: 20110518 DATE AS OF CHANGE: 20110518 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PIGNATELLI FEDERICO CENTRAL INDEX KEY: 0001270560 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19627 FILM NUMBER: 11854232 MAIL ADDRESS: STREET 1: BIOLASE TECHNOLOGY INC STREET 2: 4 CROMWELL CITY: IRVINE STATE: CA ZIP: 92618 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: 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: 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 4 1 doc4.xml FORM 4 SUBMISSION X0303 4 2011-05-18 0 0000811240 BIOLASE TECHNOLOGY INC BLTI 0001270560 PIGNATELLI FEDERICO 4 CROMWELL IRVINE CA 92618 1 1 0 0 Chairman and CEO Common Stock 2011-05-18 4 M 0 8750 1.45 A 1616500 D Common Stock 2011-05-18 4 M 0 8750 1.45 A 1625250 D Stock Option (right to buy) 1.45 2011-05-18 4 M 0 8750 1.45 D 2010-07-02 2010-07-02 Common Stock 8750 208750 D Stock Option (right to buy) 1.45 2011-05-18 4 M 0 8750 1.45 D 2010-07-02 2020-07-02 Common Stock 8750 200000 D The shares acquired vest, and the Company's right of repurchase of such shares lapses, on July 2, 2011, subject to (i) the Reporting Person's continued service as a director until such date, and (ii) the immediate vesting in full of such shares if certain changes in control or ownership occur, or if the Reporting Person dies or becomes disabled while serving as a director. /s/ Michael C. Carroll, Attorney-in-fact for Federico Pignatelli 2011-05-18