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