0001209191-13-058122.txt : 20131220
0001209191-13-058122.hdr.sgml : 20131220
20131220142957
ACCESSION NUMBER: 0001209191-13-058122
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20131210
FILED AS OF DATE: 20131220
DATE AS OF CHANGE: 20131220
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LOW SAMUEL BERNARD
CENTRAL INDEX KEY: 0001594754
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-19627
FILM NUMBER: 131291109
MAIL ADDRESS:
STREET 1: 80 SURFVIEW DRIVE #613
CITY: PALM COAST
STATE: FL
ZIP: 32137
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2013-12-10
0
0000811240
BIOLASE, INC
BIOL
0001594754
LOW SAMUEL BERNARD
4 CROMWELL
IRVINE
CA
92618
1
0
0
0
Stock Option (right to buy)
1.73
2013-12-10
4
A
0
27500
0.00
A
2023-12-10
Common Stock
27500
27500
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 Samuel B. Low.
2013-12-19