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