SEC Form 4 · accession 0001140361-16-082038
BIOLASE, INC · BIOL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Period of report
Sep 30, 2016
Accepted (ET)
Oct 5, 2016 · 5:21 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000811240
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F3 | Sep 30, 2016 | C | 3,699,100 | $1.13 | A | 14,228,625 | I | See footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series C Preferred StockF3,F1,F4 | $1.13 | Sep 30, 2016 | C | 37,091 | D | — | — | Common Stock | 3,709,100 | 0 | I |
| Warrants to acquire Common StockF3,F2 | $2.00 | Sep 30, 2016 | P | 850,797 | A | — | Aug 8, 2021 | Common Stock | 850,797 | 2,194,983 | I |
Explanation of responses
- F1See Exhibit 99.1
- F2See Exhibit 99.1
- F3See Exhibit 99.1
- F4See Exhibit 99.1
Remarks
* On his own behalf or on behalf of the other joint filers. Exhibit List: Exhibit 99.1 - Explanation of Responses Exhibit 99.2 - Joint Filer Information and Signatures