0001209191-20-043538.txt : 20200723
0001209191-20-043538.hdr.sgml : 20200723
20200723184019
ACCESSION NUMBER: 0001209191-20-043538
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200722
FILED AS OF DATE: 20200723
DATE AS OF CHANGE: 20200723
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: 201044694
MAIL ADDRESS:
STREET 1: 500 WEST MAIN ST.
CITY: LOUISVILLE
STATE: KY
ZIP: 40202
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
2020-07-22
0
0000811240
BIOLASE, INC
BIOL
0001112980
LORD JONATHAN T MD
4 CROMWELL
IRVINE
CA
92618
1
0
0
0
Warrants
0.40
2020-07-22
4
A
0
15000
A
2020-07-22
2025-07-22
Common Stock
15000
15000
D
Series F Convertible Preferred
0.40
2020-07-22
4
A
0
6
A
2020-07-22
Common Stock
6
D
An investment of $1,000 in the Issuer's rights offering provided the Reporting Person with one share of Series E Preferred Stock and 2,500 Warrants, which are the subject securities reported by the Reporting Person in this Form 4.
Each share of Series F Preferred Stock will be convertible at the Issuer's option at any time on or after July 15, 2021 or at the option of the Reporting Person at any time, into the number of shares of the Issuer's common stock determined by dividing the $1,000 stated value per share of the Series E Preferred Stock by a Conversion Price of $0.40 per share.
/s/ Michael C. Carroll, attorney-in-fact for Jonathan T. Lord
2020-07-23