0001209191-22-042169.txt : 20220714 0001209191-22-042169.hdr.sgml : 20220714 20220714181312 ACCESSION NUMBER: 0001209191-22-042169 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20220706 FILED AS OF DATE: 20220714 DATE AS OF CHANGE: 20220714 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Sandor Steven CENTRAL INDEX KEY: 0001937777 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36385 FILM NUMBER: 221083811 MAIL ADDRESS: STREET 1: 27042 TOWNE CENTRE DRIVE, STREET 2: SUITE 270 CITY: FOOTHILL RANCH STATE: CA ZIP: 92610 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: 27042 TOWNE CENTRE DRIVE STREET 2: SUITE 270 CITY: FOOTHILL RANCH STATE: CA ZIP: 92610 BUSINESS PHONE: 949-361-1200 MAIL ADDRESS: STREET 1: 27042 TOWNE CENTRE DRIVE STREET 2: SUITE 270 CITY: FOOTHILL RANCH STATE: CA ZIP: 92610 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 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2022-07-06 0 0000811240 BIOLASE, INC BIOL 0001937777 Sandor Steven 27042 TOWNE CENTRE DRIVE SUITE 270 FOOTHILL RANCH CA 92610 0 1 0 0 Chief Operating Officer Common Stock 2355 D Restricted Stock Unit Common Stock 200 D Restricted Stock Unit Common Stock 1800 D Restricted Stock Unit Common Stock 450 D Restricted Stock Unit Common Stock 8544 D Stock Option (right to buy) 52.75 2029-04-08 Common Stock 800 D The restricted stock unit award vests as to 200 shares on April 8, 2023, subject to the Reporting Person's continued service with the Company. 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 vests as to 900 shares on each of August 10, 2022 and August 10, 2023, subject to the Reporting Person's continued service with the Company. The restricted stock unit award vests as to 450 shares on August 5, 2022, subject to the Reporting Person's continued service with the Company. The restricted stock unit award vests in accordance with performance criteria established by the Compensation Committee of the Company, subject to the Reporting Person's continued service with the Company. The stock option vests immediately as to 201 shares, and the remainder vests ratably over a 36-month period, commencing on May 8, 2020, subject to the Reporting Person's continued service with the Company. /s/ Michael C. Carroll, attorney-in-fact for Steven Sandor 2022-07-14 EX-24 2 poa.txt POA DOCUMENT LIMITED POWER OF ATTORNEY Know all by these presents, that the undersigned hereby authorizes Michael C. Carroll to execute for and on behalf of the undersigned, in the undersigneds capacity as a Section 16 reporting person of Biolase, Inc., a Delaware corporation (the Company), EDGAR Form ID (including amendments thereto) and Authenticating Statements, Forms 3, 4 and 5, and any amendments thereto, and cause such form(s) to be filed with the United States Securities and Exchange Commission and The NASDAQ Stock Market. The undersigned hereby grants to such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-facts substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorney-in-fact, in serving in such capacity at the request of the undersigned, is not assuming, nor is the Company assuming, any of the undersigneds responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended or the rules promulgated thereunder. This Limited Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigneds holdings of, and transactions in, securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorney-in-fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 12th day of July, 2022. By: /s/ Steven Sandor Print Name: Steven Sandor