Form Type: 4

SEC EDGAR Link
Accession Number:0001209191-21-040458
Date:2021-06-11
Issuer: BIOLASE, INC (BIOL)
Original Submission Date:

Reporting Person:

ROPER JESS
27042 TOWNE CENTRE DR.
SUITE 270 FOOTHILL RANCH, CA 92610

Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
Title of SecurityTransaction Date2a. Deemed Execution Date Transaction CodeSharesAcquired or DisposedPrice per share 5. Amount of Securities Beneficially Owned Following Reported Transaction 6. Ownership Form Direct or IndirectNature of Indirect Ownership
Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, convertible securities
Title of Derivative Security Conversion or Exercise Price of Derivative Security Transaction Date Deemed Execution Date Transaction Code Number of Derivative Securities Acquired (A) or Disposed of (D) Date ExercisableExpiration Date Title and Amount of Securities Underlying Derivative Security Price of Derivative Security Number of derivative Securities Beneficially Owned Following Reported Transaction(s) Ownership Form: Direct (D) or Indirect (I) Nature of Indirect Beneficial Ownership
STOCK APPRECIATION RIGHT 0.84 2021-06-11 deemed execution date A 111,337 (a) 2031-06-11 common stock 111,337 $0.84 111,337 direct
RESTRICTED STOCK UNIT 0.0 2021-06-11 deemed execution date A 138,000 (a) common stock 138,000 $0.00 138,000 direct
Footnotes
IDfootnote
f1 of the stock appreciation rights subject to this sar, one-fourth of the stock appreciation rights vest on each of the third, sixth, ninth, and twelfth-month anniversaries of the date of grant.
f2 at the option of the company, each restricted stock unit represents the right to receive, at settlement, one share of common stock, or its cash equivalent.
f3 the restricted stock unit award fully vests and is immediately exercisable upon the filing with the sec of the annual report on form 10-k for the year ending december 31, 2023,
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