SEC Form 4 · accession 0001209191-17-064129
BIOLASE, INC · BIOL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Harold C Flynn Jr.
Officer — President and CEO · Director
Period of report
Dec 5, 2017
Accepted (ET)
Dec 6, 2017 · 11:16 am EST
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 | Dec 5, 2017 | X | 65,870 | $0.456 | A | 131,970 | I | By Trust |
| Common Stock | holding | — | — | — | 96,720 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Subscription Rights (Right to Buy)F2,F3 | $0.456 | Dec 5, 2017 | X | 65,870 | D | Nov 8, 2017 | Nov 29, 2017 | Common Stock | 65,870 | 0 | I |
Explanation of responses
- F1The Common Stock is held directly by the Flynn Living Trust (the "Trust"). Mr. Flynn serves as a co-trustee to the Trust and his daughter is the beneficiary of the Trust.
- F2The Subscription Rights were held directly by the Trust. Mr. Flynn serves as a co-trustee to the Trust and his daughter is the beneficiary of the Trust.
- F3The Reporting Person disclaims beneficial ownership of the Subscription Rights except to the extent of his pecuniary interest therein, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the Subscription Rights for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose.