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