0001209191-12-052619.txt : 20121113 0001209191-12-052619.hdr.sgml : 20121112 20121113092956 ACCESSION NUMBER: 0001209191-12-052619 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121108 FILED AS OF DATE: 20121113 DATE AS OF CHANGE: 20121113 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: 121196278 MAIL ADDRESS: STREET 1: BIOLASE TECHNOLOGY INC STREET 2: 4 CROMWELL CITY: IRVINE STATE: CA ZIP: 92618 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2012-11-08 0 0000811240 BIOLASE, INC BIOL 0001270560 PIGNATELLI FEDERICO 4 CROMWELL IRVINE CA 92618 1 1 0 0 Chairman and CEO Stock Option (right to buy) 2.50 2012-11-08 4 A 0 100000 0.00 A 2022-11-08 Common Stock 100000 270000 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, and shall vest and be exercisable immediately upon a change of control. /s/ Michael C. Carroll, Attorney-in-Fact for Federico Pignatelli 2012-11-12