SEC Form 4 · accession 0001140361-17-027133
BIOLASE, INC · BIOL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Period of report
Jun 30, 2017
Accepted (ET)
Jul 5, 2017 · 4:19 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 | Jun 30, 2017 | C | 3,698,600 | $1.24 | A | 18,320,650 | 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 D Preferred StockF3,F1 | $1.24 | Jun 30, 2017 | C | 36,986 | D | — | — | Common Stock | 3,698,600 | 0 | I |
| Warrants to acquire Common StockF3,F2 | $1.80 | Jun 30, 2017 | P | 1,800,535 | A | — | Oct 18, 2022 | Common Stock | 1,800,535 | 3,144,811 | I |
Explanation of responses
- F1See Exhibit 99.1.
- F2See Exhibit 99.1.
- F3See 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