SEC Form 4 · accession 0001209191-17-031227
BIOLASE, INC · BIOL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Paul N Clark
Director
Period of report
May 8, 2017
Accepted (ET)
May 10, 2017 · 4:11 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 | May 8, 2017 | M | 96,250 | — | A | 96,250 | D | |
| Common StockF2 | holding | — | — | — | 221,200 | I | See Footnote | |
| Common StockF3 | holding | — | — | — | 1,155,257 | I | By Trust |
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,F4 | — | May 8, 2017 | M | 96,250 | D | — | — | Common Stock | 96,250 | 0 | D |
Explanation of responses
- F1Each restricted stock unit represents the right to receive, at settlement, one share of common stock.
- F2The Common Stock is held directly by PNC Investments LLC ("PNC"). Mr. Clark is the sole managing member of PNC.
- F3The Common Stock is held directly by held by the Paul and Carolyn Clark Revocable Trust of 2009. Mr. Clark is the trustee of the Paul and Carolyn Clark Revocable Trust of 2009.
- F4On May 6, 2016, the reporting person was granted 96,250 restricted stock units, which vested on May 6, 2017.