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SCHEDULE 13D
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CUSIP No: 090911108
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Page 2 of 9 Pages
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1
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NAMES OF REPORTING PERSONS
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JACK W. SCHULER
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
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(a) [ ]
(b) [ ]
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3
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SEC USE ONLY
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4
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SOURCE OF FUNDS (SEE INSTRUCTIONS)
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PF
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5
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CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEM 2(D) OR 2(E)
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[ ] |
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6
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CITIZENSHIP OR PLACE OF ORGANIZATION
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UNITED STATES
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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7
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SOLE VOTING POWER
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0
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8
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SHARED VOTING POWER
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16,144,902 (1)
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9
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SOLE DISPOSITIVE POWER
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0
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10
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SHARED DISPOSITIVE POWER
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16,144,902 (1)
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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16,144,902 (1)
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12
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CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
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[ ] |
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13
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
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26.06% (2)
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14
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TYPE OF REPORTING PERSON
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IN
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SCHEDULE 13D
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CUSIP No: 090911108
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Page 3 of 9 Pages
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1
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NAMES OF REPORTING PERSONS
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JACK W. SCHULER LIVING TRUST
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
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(a) [ ]
(b) [ ]
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3
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SEC USE ONLY
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4
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SOURCE OF FUNDS (SEE INSTRUCTIONS)
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WC
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5
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CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEM 2(D) OR 2(E)
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[ ] |
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6
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CITIZENSHIP OR PLACE OF ORGANIZATION
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ILLINOIS
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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7
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SOLE VOTING POWER
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0
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8
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SHARED VOTING POWER
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10,246,637 (1)
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9
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SOLE DISPOSITIVE POWER
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0
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10
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SHARED DISPOSITIVE POWER
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10,246,637 (1)
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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10,246,637 (1)
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12
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CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
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[ ] |
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13
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
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16.54% (2)
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14
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TYPE OF REPORTING PERSON
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CO
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SCHEDULE 13D
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CUSIP No: 090911108
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Page 4 of 9 Pages
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1
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NAMES OF REPORTING PERSONS
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RENATE SCHULER
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
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(a) [ ]
(b) [ ]
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3
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SEC USE ONLY
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4
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SOURCE OF FUNDS (SEE INSTRUCTIONS)
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OO
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5
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CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEM 2(D) OR 2(E)
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[ ] |
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6
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CITIZENSHIP OR PLACE OF ORGANIZATION
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United States
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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7
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SOLE VOTING POWER
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0
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8
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SHARED VOTING POWER
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5,898,265 (1)
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9
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SOLE DISPOSITIVE POWER
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0
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10
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SHARED DISPOSITIVE POWER
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5,898,265 (1)
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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5,898,265 (1)
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12
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CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
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[ ] |
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13
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
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10.12% (2)
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14
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TYPE OF REPORTING PERSON
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IN
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SCHEDULE 13D
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CUSIP No: 090911108
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Page 5 of 9 Pages
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1
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NAMES OF REPORTING PERSONS
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SCHULER FAMILY FOUNDATION
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
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(a) [ ]
(b) [ ]
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|||
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||||
3
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SEC USE ONLY
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4
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SOURCE OF FUNDS (SEE INSTRUCTIONS)
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WC
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5
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CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEM 2(D) OR 2(E)
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[ ] |
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|||
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6
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CITIZENSHIP OR PLACE OF ORGANIZATION
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Illinois
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||||
NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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7
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SOLE VOTING POWER
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0
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8
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SHARED VOTING POWER
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5,883,465 (1)
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9
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SOLE DISPOSITIVE POWER
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0
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10
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SHARED DISPOSITIVE POWER
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5,883,465 (1)
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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5,883,465 (1)
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12
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CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
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[ ] |
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|||
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||||
13
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
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10.10% (2)
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14
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TYPE OF REPORTING PERSON
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CO
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SCHEDULE 13D
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Page 6 of 9 Pages
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Item 1. | Security and Issuer |
Item 3. | Source and Amount of Funds or Other Consideration |
Item 4. | Purpose of Transaction |
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SCHEDULE 13D
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Page 7 of 9 Pages
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Item 5. | Interest in Securities of the Issuer |
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SCHEDULE 13D
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Page 8 of 9 Pages
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Item 6. | Contracts, Arrangements, Understandings or Relationships with Respect to Securities of the Issuer. |
Item 7. | Material to be Filed as Exhibits. |
Exhibit I: | Securities Purchase Agreement, dated August 1, 2016, among Biolase, Inc. and the investors listed on Schedule I thereto (incorporated by reference to Exhibit 99.1 to the Current Report on Form 8-K filed by the Issuer on August 2, 2016). |
Exhibit J: | Form of Certificate of Designations (incorporated by reference to Exhibit A to the Securities Purchase Agreement filed as Exhibit 99.1 to the Current Report on Form 8-K filed by the Issuer on August 2, 2016). |
Exhibit K: | Form of Warrant (incorporated by reference to Exhibit B to the Securities Purchase Agreement filed as Exhibit 99.1 to the Current Report on Form 8-K filed by the Issuer on August 2, 2016). |
Exhibit L: | Amendment to Standstill Agreement, dated August 1, 2016, by and among Jack W. Schuler, Renate Schuler, Schuler Family Foundation and Biolase, Inc. (incorporated by reference to Exhibit 99.2 of the Current Report on Form 8-K filed by the Issuer on August 2, 2016). |
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SCHEDULE 13D
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Page 9 of 9 Pages
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Jack W. Schuler
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/s/ Jack W. Schuler
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Jack W. Schuler Living Trust
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By:
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/s/ Jack W. Schuler
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Name:
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Jack W. Schuler
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Title:
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Trustee
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Renate Schuler
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/s/ Renate Schuler
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Schuler Family Foundation
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/s/ Jack W. Schuler
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Name:
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Jack W. Schuler
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Title:
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President
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