0001209191-15-068588.txt : 20150831
0001209191-15-068588.hdr.sgml : 20150831
20150831145934
ACCESSION NUMBER: 0001209191-15-068588
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150827
FILED AS OF DATE: 20150831
DATE AS OF CHANGE: 20150831
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: CLARK PAUL N
CENTRAL INDEX KEY: 0001222248
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36385
FILM NUMBER: 151084640
MAIL ADDRESS:
STREET 1: 5301 STEVENS CREEK BLVD
STREET 2: MS 1A-LC
CITY: SANTA CLARA
STATE: CA
ZIP: 95051
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-08-27
0
0000811240
BIOLASE, INC
BIOL
0001222248
CLARK PAUL N
4 CROMWELL
IRVINE
CA
92603
1
0
0
0
Common Stock
2015-08-27
4
M
0
9217
A
1020678
D
Restricted Stock Unit
2015-08-27
4
M
0
9217
0.00
D
Common Stock
9217
0
D
Restricted stock units covert into common stock on a one-for-one basis.
Of the 1,020,678 shares reported by the reporting person, 1,011,461 of such shares are held indirectly by trust.
On August 27, 2014, the reporting person was granted 9,217 restricted stock units, vesting on the first anniversary of the grant date.
/s/ Michael C. Carroll, attorney-in-fact for Paul N. Clark.
2015-08-31