Initial Statement of Beneficial Ownership (3)
July 14 2022 - 6:10PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Bright Jennifer |
2. Date of Event Requiring Statement (MM/DD/YYYY)
7/6/2022
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3. Issuer Name and Ticker or Trading Symbol
BIOLASE, INC [BIOL]
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(Last)
(First)
(Middle)
27042 TOWNE CENTRE DRIVE, SUITE 270 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) Chief Financial Officer / |
(Street)
FOOTHILL RANCH, CA 92610
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 160 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Restricted Stock Unit | (1) | (1) | Common Stock | 600 | (2) | D | |
Restricted Stock Unit | (3) | (3) | Common Stock | 3600 | (2) | D | |
Restricted Stock Unit | (4) | (4) | Common Stock | 13500 | (2) | D | |
Stock Option (right to buy) | (5) | 2/15/2031 | Common Stock | 800 | $32.25 | D | |
Explanation of Responses: |
(1) | The restricted stock unit award vests as to 200 shares on each of February 15, 2023, February 15, 2024, and February 15, 2025, subject to the Reporting Person's continued service with the Company. |
(2) | At the option of the Company, each restricted stock unit represents the right to receive, at settlement, one share of common stock, or its cash equivalent. |
(3) | The restricted stock unit award vests as to 1,800 shares on each of August 10, 2022 and August 10, 2023, subject to the Reporting Person's continued service with the Company. |
(4) | The restricted stock unit award vests in accordance with performance criteria established by the Compensation Committee of the Company, subject to the Reporting Person's continued service with the Company. |
(5) | The stock option vests immediately as to 201 shares, and the remainder vests ratably over a 36-month period, commencing on March 15, 2022, subject to the Reporting Person's continued service with the Company. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Bright Jennifer 27042 TOWNE CENTRE DRIVE SUITE 270 FOOTHILL RANCH, CA 92610 |
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| Chief Financial Officer |
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Signatures
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/s/ Michael C. Carroll, attorney-in-fact for Jennifer Bright | | 7/14/2022 |
**Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
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