0001209191-17-031221.txt : 20170510 0001209191-17-031221.hdr.sgml : 20170510 20170510160912 ACCESSION NUMBER: 0001209191-17-031221 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170508 FILED AS OF DATE: 20170510 DATE AS OF CHANGE: 20170510 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: MOLL FREDERIC H CENTRAL INDEX KEY: 0001260157 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36385 FILM NUMBER: 17830295 MAIL ADDRESS: STREET 1: C/O INTUITIVE SURGICAL INC STREET 2: 950 KIFER ROAD CITY: SUNNYVALE STATE: CA ZIP: 94086 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-05-08 0 0000811240 BIOLASE, INC BIOL 0001260157 MOLL FREDERIC H 4 CROMWELL IRVINE CA 92618 1 0 0 0 Common Stock 2017-05-08 4 M 0 50000 A 59217 D Restricted Stock Unit 2017-05-08 4 M 0 50000 0.00 D Common Stock 50000 0 D Each restricted stock unit represents the right to receive, at settlement, one share of common stock. On May 6, 2016, the reporting person was granted 50,000 restricted stock units, which vested on May 6, 2017. /s/ Michael C. Carroll, attorney-in-fact for Frederic H. Moll 2017-05-10