0001209191-21-051428.txt : 20210813
0001209191-21-051428.hdr.sgml : 20210813
20210813170300
ACCESSION NUMBER: 0001209191-21-051428
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210811
FILED AS OF DATE: 20210813
DATE AS OF CHANGE: 20210813
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BEAVER JOHN R
CENTRAL INDEX KEY: 0001215999
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36385
FILM NUMBER: 211173211
MAIL ADDRESS:
STREET 1: C/O STERLING CHEMICALS INC
STREET 2: 1200 SMITH STREET
CITY: HOUSTON
STATE: TX
ZIP: 77002
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
2021-08-11
0
0000811240
BIOLASE, INC
BIOL
0001215999
BEAVER JOHN R
27042 TOWNE CENTRE DRIVE
SUITE 270
FOOTHILL RANCH
CA
92610
1
1
0
0
President & CEO
Stock Appreciation Right
0.63
2021-08-11
4
A
0
220000
0.00
A
2031-08-11
Common Stock
220000
220000
D
Of the stock appreciation rights subject to this SAR, one-half of the stock appreciation rights vest on the first anniversary of the date of grant, and one-half of the stock appreciation rights vest on the second anniversary of the date of grant.
/s/ Michael C. Carroll, attorney-in-fact for John R. Beaver
2021-08-13