0001209191-17-031889.txt : 20170512 0001209191-17-031889.hdr.sgml : 20170512 20170512160825 ACCESSION NUMBER: 0001209191-17-031889 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170510 FILED AS OF DATE: 20170512 DATE AS OF CHANGE: 20170512 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: 17838644 MAIL ADDRESS: STREET 1: 500 WEST MAIN ST. CITY: LOUISVILLE STATE: KY ZIP: 40202 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-05-10 0 0000811240 BIOLASE, INC BIOL 0001112980 LORD JONATHAN T MD 4 CROMWELL IRVINE CA 92618 1 0 0 0 Stock Option (right to buy) 1.21 2017-05-10 4 A 0 105634 0.00 A 2027-05-10 Common Stock 105634 427118 D Restricted Stock Unit 2017-05-10 4 A 0 35211 0.00 A Common Stock 35211 35211 D The stock option vests and is exercisable in equal monthly installments over a consecutive 12-month period, commencing one month from the date of grant. Each restricted stock unit represents the right to receive, at settlement, one share of common stock. The restricted stock unit award fully vests and is immediately exercisable on the first anniversary of the date of the award. /s/ Michael C. Carroll, attorney-in-fact for Jonathan T. Lord 2017-05-12