-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, MbAXUyLvssThSM736AK9k5KuI44ZygD/9RKl1GLCeXMnJBaejX5r8pW8AWZ7+Z2l o+wbEO1O4T7ta8ug0QHQYg== 0001358010-06-000009.txt : 20060421 0001358010-06-000009.hdr.sgml : 20060421 20060421180246 ACCESSION NUMBER: 0001358010-06-000009 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20060420 FILED AS OF DATE: 20060421 DATE AS OF CHANGE: 20060421 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BIOLASE TECHNOLOGY 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: 981 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 BUSINESS PHONE: 7143611200 MAIL ADDRESS: STREET 1: 981 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 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 FORMER COMPANY: FORMER CONFORMED NAME: PAMPLONA CAPITAL CORP DATE OF NAME CHANGE: 19911104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: dArbeloff George V CENTRAL INDEX KEY: 0001295298 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19627 FILM NUMBER: 06773653 BUSINESS ADDRESS: BUSINESS PHONE: 949-361-1200 MAIL ADDRESS: STREET 1: C/O BIOLASE TECHNOLOGY, INC. STREET 2: 981 CALLE AMANECER CITY: SAN CLEMENTE STATE: CA ZIP: 92673 4 1 primary_doc.xml PRIMARY DOCUMENT X0202 4 2006-04-20 0 0000811240 BIOLASE TECHNOLOGY INC BLTI 0001295298 dArbeloff George V C/O BIOLASE TECHNOLOGY, INC. 981 CALLE AMANECER SAN CLEMENTE CA 92673 1 0 0 0 Stock Option (right to buy) 10.4 2006-04-20 4 A 0 30000 0 A 2016-04-20 Common Stock 30000 30000 D Each automatic option is immediately exercisable for all of the option shares. However, any shares purchased under such option are subject to repurchase by the Issuer, at the lower of the exercise price paid per share or the fair market value per share (determined at the time of repurchase), should the Reporting Person cease Board service prior to vesting of those shares. The shares vest, and the Company's right of repurchase lapses, in four successive quarterly installments upon the Reporting Person's completion of each quarter of service as a non-employee director measured from the grant date. The shares subject to the option grant will immediately vest in full if certain changes in control or ownership occur or if the Reporting Person dies or becomes disabled while serving as a director. /s/ Richard L. Harrison, Attorney-in-Fact 2006-04-21 EX-24 2 poadarbeloff.txt POWER OF ATTORNEY POWER OF ATTORNEY Know all by these presents, that the undersigned hereby authorizes Richard L. Harrison of Biolase Technology, Inc. "BLTI"), to execute for and on behalf of the undersigned, in the undersigned's capacity as a Section 16 reporting person of BLTI, 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 each 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-fact's 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 attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is BLTI assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934, as amended or the rules promulgated thereunder. This 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 undersigned's holdings of, and transactions in, securities issued by BLTI, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact. IN WITNESS Whereof, the undersigned has cause this Power of Attorney to be executed as of this 2nd day of February, 2006. /s/ George V. d'Arbeloff George V. d'Arbeloff -----END PRIVACY-ENHANCED MESSAGE-----