Initial Statement of Beneficial Ownership (3)
July 14 2022 - 6:13PM
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
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Sandor Steven |
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 Operating 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 | 2355 | 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 | 200 | (2) | D | |
Restricted Stock Unit | (3) | (3) | Common Stock | 1800 | (2) | D | |
Restricted Stock Unit | (4) | (4) | Common Stock | 450 | (2) | D | |
Restricted Stock Unit | (5) | (5) | Common Stock | 8544 | (2) | D | |
Stock Option (right to buy) | (6) | 4/8/2029 | Common Stock | 800 | $52.75 | D | |
Explanation of Responses: |
(1) | The restricted stock unit award vests as to 200 shares on April 8, 2023, 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 900 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 as to 450 shares on August 5, 2022, subject to the Reporting Person's continued service with the Company. |
(5) | 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. |
(6) | The stock option vests immediately as to 201 shares, and the remainder vests ratably over a 36-month period, commencing on May 8, 2020, 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 |
Sandor Steven 27042 TOWNE CENTRE DRIVE SUITE 270 FOOTHILL RANCH, CA 92610 |
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| Chief Operating Officer |
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Signatures
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/s/ Michael C. Carroll, attorney-in-fact for Steven Sandor | | 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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