0001209191-21-040456.txt : 20210614 0001209191-21-040456.hdr.sgml : 20210614 20210614205013 ACCESSION NUMBER: 0001209191-21-040456 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210611 FILED AS OF DATE: 20210614 DATE AS OF CHANGE: 20210614 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: 211016415 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 2021-06-11 0 0000811240 BIOLASE, INC BIOL 0001112980 LORD JONATHAN T MD 27042 TOWNE CENTRE DR. SUITE 270 FOOTHILL RANCH CA 92610 1 0 0 0 Stock Appreciation Right 0.84 2021-06-11 4 A 0 189902 0.00 A 2031-06-11 Common Stock 189902 189902 D Restricted Stock Unit 2021-06-11 4 A 0 330000 0.00 A Common Stock 330000 330000 D Of the stock appreciation rights subject to this SAR, one-fourth of the stock appreciation rights vest on each of the third, sixth, ninth, and twelfth-month anniversaries of the date of grant. At the option of the Company, each restricted stock unit represents the right to receive, at settlement, one share of common stock, or its cash equivalent. The restricted stock unit award fully vests and is immediately exercisable upon the filing with the SEC of the Annual Report on Form 10-K for the year ending December 31, 2023. /s/ Michael C. Carroll, attorney-in-fact for Jonathan T. Lord 2021-06-14