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