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SCHEDULE 13D
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CUSIP No: 090911108
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Page 2 of 7 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)
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☐
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(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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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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22,572,152 (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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22,572,152 (1)
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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22,572,152 (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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28.69% (2)
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14
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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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 7 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)
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☐
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(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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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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11,089,552 (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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11,089,552 (1) |
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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11,089,552 (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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14.43% (1)
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14
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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OO
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SCHEDULE 13D
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CUSIP No: 090911108
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Page 4 of 7 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)
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☐
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(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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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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||||
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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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11,482,600 (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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11,482,600 (1)
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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11,482,600 (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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14.76% (2) |
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14
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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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 7 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
|
CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
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(a)
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☐
|
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(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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|
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WC
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|||
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|
||||
5
|
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
|
SOLE VOTING POWER
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0
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|||
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||||
8
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SHARED VOTING POWER
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11,382,600 (1)
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|||
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||||
9
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SOLE DISPOSITIVE POWER
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0
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|||
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||||
10
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SHARED DISPOSITIVE POWER
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11,382,600 (1)
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|||
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||||
11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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11,382,600 (1) |
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|||
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||||
12
|
CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
|
|
☐
|
||
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|
||||
|
|
||||
13
|
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
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14.97% (2)
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|||
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|
||||
14
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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CO |
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SCHEDULE 13D
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CUSIP No: 090911108
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Page 6 of 7 Pages
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Item 1. |
Security and Issuer
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Item 4. |
Purpose of Transaction
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Item 6. |
Contracts, Arrangements, Understandings or Relationships with Respect to Securities of the Issuer.
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Item 7. |
Material to be Filed as Exhibits
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SCHEDULE 13D
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Page 7 of 7 Pages
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JACK W. SCHULER
|
|||
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/s/ Jack W. Schuler |
JACK W. SCHULER LIVING TRUST | |||
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By:
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/s/ Jack W. Schuler | |
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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|||
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/s/ Renate Schuler
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SCHULER FAMILY FOUNDATION
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|||
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By:
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/s/ Jack W. Schuler | |
Name:
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Jack W. Schuler
|
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Title:
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President
|
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Investor
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Commitment
|
|||
Renate Schuler
|
$
|
0
|
||
Jack W. Schuler Living Trust
|
$
|
0
|
||
Schuler Family Foundation
|
$
|
3,000,000
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INVESTORS: | |||
RENATE SCHULER | |||
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By:
|
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JACK W. SCHULER LIVING TRUST | |||
By: | |||
Jack W. Schuler | |||
Trustee | |||
SCHULER FAMILY FOUNDATION | |||
By: | |||
Jack W. Schuler | |||
President |
ACCEPTED AND AGREED:
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BIOLASE, INC.
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By: | |||
Harold C. Flynn Jr. | |||
President and Chief Executive | |||
Officer |