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