SEC Form 4 · accession 0001209191-17-064132
BIOLASE, INC · BIOL
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jonathan T Lord M.D.
Director
Period of report
Dec 5, 2017
Accepted (ET)
Dec 6, 2017 · 11:20 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 Stock | Dec 5, 2017 | X | 100,000 | $0.456 | A | 467,145 | 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) | $0.456 | Dec 5, 2017 | X | 100,000 | D | Nov 8, 2017 | Nov 29, 2017 | Common Stock | 100,000 | 0 | D |