0001209191-18-029962.txt : 20180514 0001209191-18-029962.hdr.sgml : 20180514 20180514174925 ACCESSION NUMBER: 0001209191-18-029962 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180511 FILED AS OF DATE: 20180514 DATE AS OF CHANGE: 20180514 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LORD JONATHAN T MD CENTRAL INDEX KEY: 0001112980 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36385 FILM NUMBER: 18832190 MAIL ADDRESS: STREET 1: 500 WEST MAIN ST. CITY: LOUISVILLE STATE: KY ZIP: 40202 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 2018-05-11 0 0000811240 BIOLASE, INC BIOL 0001112980 LORD JONATHAN T MD 4 CROMWELL IRVINE CA 92618 1 0 0 0 Common Stock 2018-05-11 4 M 0 7042 A 100470 D Restricted Stock Unit 2018-05-11 4 M 0 7042 0.00 D Common Stock 7042 0 D Restricted Stock Unit 2018-05-14 4 A 0 27312 0.00 A Common Stock 27312 27312 D Restricted Stock Unit 2018-05-14 4 A 0 144828 0.00 A Common Stock 144828 172140 D Each restricted stock unit represents the right to receive, at settlement, one share of common stock. On May 10, 2017, the reporting person was granted 35,211 restricted stock units, which vested on May 11, 2018. On May 10, 2018, the Company issued a press release announcing that, at the Annual Meeting, the Company's stockholders approved a proposal to amend the Company's Restated Certificate of Incorporation to effect a reverse stock split of Company common stock at a ratio of not less than 1-for-5 and not more than 1-for-15, with the final ratio to be determined by the Board. Immediately after the Annual Meeting, the Board approved the reverse stock split at a ratio of one post-split share for every five pre-split shares. The restricted stock units vest as follows: (i) two-fifths of the restricted stock units vest on December 31, 2018, and (ii) three-fifths of the restricted stock units vest on December 31, 2019. The restricted stock unit award fully vests and is immediately exercisable on the first anniversary of the date of the award. /s/ Michael C. Carroll, attorney-in-fact for Jonathan T. Lord 2018-05-14