0000905148-16-001934.txt : 20161007
0000905148-16-001934.hdr.sgml : 20161007
20161007125140
ACCESSION NUMBER: 0000905148-16-001934
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20151021
FILED AS OF DATE: 20161007
DATE AS OF CHANGE: 20161007
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Jack W. Schuler Living Trust
CENTRAL INDEX KEY: 0001661351
STATE OF INCORPORATION: IL
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36385
FILM NUMBER: 161926797
BUSINESS ADDRESS:
STREET 1: 100 NORTH FIELD DRIVE
STREET 2: SUITE 360
CITY: LAKE FOREST
STATE: IL
ZIP: 60045
BUSINESS PHONE: 224-880-1210
MAIL ADDRESS:
STREET 1: 100 NORTH FIELD DRIVE
STREET 2: SUITE 360
CITY: LAKE FOREST
STATE: IL
ZIP: 60045
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SCHULER JACK W
CENTRAL INDEX KEY: 0001021412
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36385
FILM NUMBER: 161926798
MAIL ADDRESS:
STREET 1: 100 N. FIELD DRIVE
STREET 2: SUITE 360
CITY: LAKE FOREST
STATE: IL
ZIP: 60045
4/A
1
form4.xml
X0306
4/A
2015-10-21
2015-12-18
0000811240
BIOLASE, INC
BIOL
0001021412
SCHULER JACK W
100 N. FIELD DRIVE
SUITE 360
LAKE FOREST
IL
60045
true
0001661351
Jack W. Schuler Living Trust
100 NORTH FIELD DRIVE
SUITE 360
LAKE FOREST
IL
60045
true
Common Stock
2015-10-21
4
P
0
33762
0.95
A
4213429
I
By Trust
These shares of Common Stock were inadvertently omitted from the reporting person's Form 4 filed December 18, 2015, and also were omitted from the reporting person's total amount of securities beneficially owned as reported in subsequent Forms 4, until corrected in the Form 4 filed October 4, 2016.
The price reported in Column 4 is a weighted average price. These shares of Common Stock were purchased in multiple transactions at prices within a $1.00 range. The reporting person undertakes to provide to the issuer, any security holder of the issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price for each transaction reported in this Form 4.
These shares of Common Stock are held directly by the Jack W. Schuler Living Trust (the "Trust"). Mr. Schuler serves as sole trustee to the Trust.
/s/ Jack Schuler, as self and as Trustee of the Jack W. Schuler Living Trust
2016-10-06