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