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