SEC Form 4 · accession 0001209191-15-068588
BIOLASE, INC · BIOL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Paul N Clark
Director
Period of report
Aug 27, 2015
Accepted (ET)
Aug 31, 2015 · 2:59 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,F2 | Aug 27, 2015 | M | 9,217 | — | A | 1,020,678 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Restricted Stock UnitF1,F3 | — | Aug 27, 2015 | M | 9,217 | D | — | — | Common Stock | 9,217 | 0 | D |
Explanation of responses
- F1Restricted stock units covert into common stock on a one-for-one basis.
- F2Of the 1,020,678 shares reported by the reporting person, 1,011,461 of such shares are held indirectly by trust.
- F3On August 27, 2014, the reporting person was granted 9,217 restricted stock units, vesting on the first anniversary of the grant date.