SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 09/28/2017 | 3. Issuer Name and Ticker or Trading Symbol DENTSPLY SIRONA Inc. [ XRAY ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 20,012(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Option (Right to Buy) | (2) | 12/08/2019 | Common Stock | 38,000 | 33.86 | D | |
Stock Option (Right to Buy) | (2) | 02/11/2021 | Common Stock | 31,900 | 36.62 | D | |
Stock Option (Right to Buy) | (2) | 02/21/2022 | Common Stock | 25,600 | 38.74 | D | |
Stock Option (Right to Buy) | (2) | 02/25/2023 | Common Stock | 20,600 | 40.86 | D | |
Stock Option (Right to Buy) | (2) | 02/24/2024 | Common Stock | 25,300 | 45.11 | D | |
Stock Option (Right to Buy) | (3) | 02/23/2025 | Common Stock | 12,933 | 52 | D | |
Stock Option (Right to Buy) | (4) | 02/17/2026 | Common Stock | 15,000 | 55.91 | D | |
Phantom Stock (Supplemental Executive Retirement Plan) SERP | (5) | (5) | Common Stock | 16,457.928 | (5) | D | |
PRSU (Performance Measured Restricted Stock Unit) | (6) | (6) | Common Stock | 4,673.916(7) | (6) | D | |
RSU (Restricted Stock Unit) | (8) | (8) | Common Stock | 8,349.605(9) | (8) | D | |
Stock Option (Right to Buy) | (10) | 09/28/2027 | Common Stock | 52,200 | 59.23 | D |
Explanation of Responses: |
1. Includes 10,105 Restricted Stock Units (RSUs) granted 9/28/2017. |
2. This option is fully vested and exercisable. |
3. Stock Options vest in annual one-third (1/3) increments over a three-year period ending February 23, 2018. |
4. Stock Options vest in annual one-third (1/3) increments over a three-year period ending February 17, 2019. |
5. The shares of phantom stock become payable in common stock upon the reporting persons termination of employment. |
6. PRSUs vest in full three years from date of grant and convert into common stock on a 1:1 basis for no additional consideration. |
7. Includes 4,607 Performance Restricted Stock Units (PRSUs) and 66.916 dividends on PRSUs. |
8. RSUs vest in full three years from date of grant and convert into common stock on a 1:1 basis for no additional consideration. |
9. Includes 8,261 Restricted Stock Units (RSUs) and 88.605 dividends on RSUs. |
10. Stock options vest December 31, 2018 or upon reporting person's termination of employment, whichever occurs first. |
Michael Friedlander, Attorney-In-Fact for Robert J. Size | 10/10/2017 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |