0001209191-17-064129.txt : 20171206 0001209191-17-064129.hdr.sgml : 20171206 20171206111657 ACCESSION NUMBER: 0001209191-17-064129 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171205 FILED AS OF DATE: 20171206 DATE AS OF CHANGE: 20171206 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Flynn Harold C Jr. CENTRAL INDEX KEY: 0001647860 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36385 FILM NUMBER: 171241482 MAIL ADDRESS: STREET 1: 4 CROMWELL CITY: IRVINE STATE: CA ZIP: 92618 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-12-05 0 0000811240 BIOLASE, INC BIOL 0001647860 Flynn Harold C Jr. C/O 4 CROMWELL IRVINE CA 92618 1 1 0 0 President and CEO Common Stock 2017-12-05 4 X 0 65870 0.456 A 131970 I By Trust Common Stock 96720 D Subscription Rights (Right to Buy) 0.456 2017-12-05 4 X 0 65870 0.00 D 2017-11-08 2017-11-29 Common Stock 65870 0 I By Trust The Common Stock is held directly by the Flynn Living Trust (the "Trust"). Mr. Flynn serves as a co-trustee to the Trust and his daughter is the beneficiary of the Trust. The Subscription Rights were held directly by the Trust. Mr. Flynn serves as a co-trustee to the Trust and his daughter is the beneficiary of the Trust. The Reporting Person disclaims beneficial ownership of the Subscription Rights except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the Subscription Rights for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose. /s/ Michael C. Carroll, attorney-in-fact for Harold C. Flynn, Jr. 2017-12-06