0001209191-12-031103.txt : 20120529 0001209191-12-031103.hdr.sgml : 20120529 20120529214303 ACCESSION NUMBER: 0001209191-12-031103 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120510 FILED AS OF DATE: 20120529 DATE AS OF CHANGE: 20120529 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Nemoy Norman J. CENTRAL INDEX KEY: 0001497017 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19627 FILM NUMBER: 12875599 MAIL ADDRESS: STREET 1: 8635 W. THIRD STREET STREET 2: #1W CITY: LOS ANGELES STATE: CA ZIP: 90048 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 X0305 4 2012-05-10 0 0000811240 BIOLASE TECHNOLOGY INC BLTI 0001497017 Nemoy Norman J. C/O 4 CROMWELL IRVINE CA 92618 1 0 0 0 Stock Option (right to buy) 2.56 2012-05-10 4 A 0 20000 0.00 A 2022-05-10 Common Stock 20000 133500 D Each automatic option is immediately exercisable for all of the option shares. However, any shares purchased under such option are subject to repurchase by the Issuer, at the lower of the exercise price paid per share or the fair market value per share (determined at the time of repurchase), should the Reporting Person cease Board service prior to vesting of those shares. The shares vest, and the Issuer's right of repurchase lapses, in four successive quarterly installments upon the Reporting Person's completion of each quarter of service as a non-employee director measured from the grant date. The shares subject to the option grant will immediately vest in full 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 Norman J. Nemoy 2011-05-29