0001209191-11-063153.txt : 20111227 0001209191-11-063153.hdr.sgml : 20111226 20111227164315 ACCESSION NUMBER: 0001209191-11-063153 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111223 FILED AS OF DATE: 20111227 DATE AS OF CHANGE: 20111227 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Furry Frederick D. CENTRAL INDEX KEY: 0001507429 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19627 FILM NUMBER: 111282478 MAIL ADDRESS: STREET 1: 18372 OXBORO LANE CITY: HUNTINGTON BEACH STATE: CA ZIP: 92648 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 X0304 4 2011-12-23 0 0000811240 BIOLASE TECHNOLOGY INC BLTI 0001507429 Furry Frederick D. C/O 4 CROMWELL IRVINE CA 92618 0 1 0 0 Chief Financial Officer Stock Option (right to buy) 2.58 2011-12-23 4 A 0 47500 0.00 A 2018-12-23 Common Stock 47500 197500 D The option granted shall vest and be exercisable in forty eight equal monthly installments, commencing one month from the grant date, over a series of forty eight successive months. /s/ Michael C. Carroll, Attorney-in-Fact for Frederick D. Furry 2011-12-27