0001209191-14-055679.txt : 20140903 0001209191-14-055679.hdr.sgml : 20140903 20140903173754 ACCESSION NUMBER: 0001209191-14-055679 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140829 FILED AS OF DATE: 20140903 DATE AS OF CHANGE: 20140903 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: LORD JONATHAN T MD CENTRAL INDEX KEY: 0001112980 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36385 FILM NUMBER: 141081368 MAIL ADDRESS: STREET 1: 500 WEST MAIN ST. CITY: LOUISVILLE STATE: KY ZIP: 40202 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2014-08-29 0 0000811240 BIOLASE, INC BIOL 0001112980 LORD JONATHAN T MD 4 CROMWELL IRVINE CA 92618 1 0 0 0 Stock Option (right to buy) 2.16 2014-08-29 4 A 0 27745 0.00 A 2024-08-29 Common Stock 27745 69173 D The option is immediately exercisable for all of the option shares. 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 Jonathan T. Lord. 2014-09-03