X0306 4 2016-08-01 0 0000811240 BIOLASE, INC BIOL 0001112980 LORD JONATHAN T MD C/O BIOLASE, INC. 4 CROMWELL IRVINE CA 92618 1 0 0 0 Series C Participating Convertible Preferred Stock 2016-08-01 4 P 0 1770 113.00 A Common Stock 177000 1770 D Warrants (right to buy) 2.00 2016-08-01 4 P 0 40708 0.125 A 2017-02-08 2021-08-08 Common Stock 40708 40708 D These shares of Series C Participating Convertible Preferred Stock ("Preferred Stock") and Warrants were acquired by Jonathan T. Lord in a private placement with the Issuer that is expected to close on August 8, 2016 (the "Closing"). Each share of Preferred Stock will initially be convertible into 100 shares of Common Stock ("Shares"), reflecting a conversion price equal to $1.13 per Share. The conversion of the Preferred Stock will occur automatically upon the Requisite Stockholder Approval (defined and described further in the Securities Purchase Agreement dated August 1, 2016 and filed as Exhibit 99.1 to the Current Report on Form 8-K filed by the Issuer on August 2, 2016), which is expected to occur after the Closing. The Preferred Stock has no expiration date. s/ Michael C. Carroll, attorney-in-fact for Jonathan T. Lord 2016-08-03