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