0001209191-21-053023.txt : 20210823
0001209191-21-053023.hdr.sgml : 20210823
20210823185504
ACCESSION NUMBER: 0001209191-21-053023
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20210812
FILED AS OF DATE: 20210823
DATE AS OF CHANGE: 20210823
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Somerman Martha J. DDS, PhD
CENTRAL INDEX KEY: 0001879393
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36385
FILM NUMBER: 211198128
MAIL ADDRESS:
STREET 1: 27042 TOWN CENTRE DRIVE
STREET 2: SUITE 270
CITY: FOOTHILL RANCH
STATE: CA
ZIP: 92610
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
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2021-08-12
1
0000811240
BIOLASE, INC
BIOL
0001879393
Somerman Martha J. DDS, PhD
27042 TOWNE CENTRE DR.
SUITE 270
FOOTHILL RANCH
CA
92610
1
0
0
0
/s/ Michael C. Carroll, attorney-in-fact for Martha Somerman
2021-08-22
EX-24.3_1005420
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
For Executing Forms ID and Form D
Know by these presents that the undersigned hereby constitutes and appoints
MICHAEL C. CARROLL, ESQ. OR PARALEGAL, PHYLLIS CUMMINGS its true and lawful
attorney-in-fact:
(1) to execute for and on behalf of the undersigned (i) Forms ID and D
(including any amendments thereto) in connection with any offering of securities
under Regulation D under the Securities Act of 1933, as amended, and (ii) any
other forms necessary to obtain or renew Securities and Exchange Commission
access codes, including but not limited to a CIK, a CCC, a Password, a Password,
Modification Authorization Code, and a Passphrase; and
(2) to take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as such attorney-in-fact may approve in his or
her discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform all and every act and thing whatsoever requisite,
necessary and proper to be done in the 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 present, with full power of substitution or revocation, hereby
ratifying and confirming all that each such attorney-in-fact, or his or her
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.
Photographic copies of this Power of Attorney shall have the same force and
effect as the original. This Power of Attorney shall remain in full force and
effect until August 17, 2021, unless earlier revoked by the undersigned in a
signed writing delivered to the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 17th day of August, 2021.
By: /s/ Martha Somerman, DDS