SEC FORM
3
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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| 221 W PHILADELPHIA ST, STE 60W |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
03/05/2018
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3. Issuer Name and Ticker or Trading Symbol
DENTSPLY SIRONA Inc.
[ XRAY ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
Director |
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10% Owner |
| X |
Officer (give title below) |
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Other (specify below) |
| Sr Vice President, EMEA RCO |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
|
Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
|
2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common Stock |
9,658.101 |
D |
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Stock Option (Right to Buy) |
|
12/08/2018 |
Common Stock |
23,400 |
25.91 |
D |
|
| Stock Option (Right to Buy) |
|
12/08/2019 |
Common Stock |
25,300 |
33.86 |
D |
|
| Stock Option (Right to Buy) |
|
02/11/2021 |
Common Stock |
22,900 |
36.62 |
D |
|
| Stock Option (Right to Buy) |
|
02/21/2022 |
Common Stock |
17,700 |
38.74 |
D |
|
| Stock Option (Right to Buy) |
|
02/24/2024 |
Common Stock |
14,300 |
45.11 |
D |
|
| Stock Option (Right to Buy) |
|
02/25/2023 |
Common Stock |
13,600 |
40.86 |
D |
|
| Stock Option (Right to Buy) |
|
02/23/2025 |
Common Stock |
12,800 |
52 |
D |
|
| Stock Option (Right to Buy) |
|
02/17/2026 |
Common Stock |
9,900 |
55.91 |
D |
|
| Stock Option (Right to Buy) |
|
02/22/2027 |
Common Stock |
9,400 |
62.34 |
D |
|
| Stock Option (Right to Buy) |
|
08/11/2027 |
Common Stock |
1,100 |
55.33 |
D |
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| Explanation of Responses: |
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Dane Baumgardner, Attorney-In-Fact for Markus Boehringer |
03/15/2018 |
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** 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. |
DENTSPLY SIRONA Inc.
Limited Power of Attorney for Section 16 Reporting
Obligations
Know all by these presents that the undersigned
hereby constitutes and appoints each of Keith Ebling,
and Dane Baumgardner, or either of them acting singly
and with full power of substitution, the
undersigned's true and lawful attorney-in-fact to:
1. Execute for and on behalf of the
undersigned, in the undersigned's capacity as an
officer or director or both of DENTSPLY SIRONA Inc.
(the "Company"), Forms 3, 4 and 5 (and any amendments
thereto) in accordance with Section 16(a) of the
Securities Exchange Act of 1934, as amended (the
"Exchange Act"), and the rules thereunder;
2. To perform any and all acts for and on
behalf of the undersigned which may be necessary or
desirable to complete and execute any such Forms 3, 4
or 5, complete and execute any amendments thereto,
and timely file such forms with the U.S. Securities
and Exchange Commission (the "SEC") and any
securities exchange or similar authority, including
without limitation the filing of a Form ID or any
other documents necessary or appropriate to enable
the undersigned to file the Forms 3, 4 and 5
electronically with the SEC;
3. Seek or obtain, as the undersigned's
representative and on the undersigned's behalf,
information on transactions in the Company's
securities from any third party, including brokers,
employee benefit plan administrators and trustees,
and the undersigned hereby authorizes any such person
to release any such information to each of the
undersigned's attorneys-in-fact appointed by this
Limited Power of Attorney and approves and ratifies
any such release of information;
4. Take any other action in connection with
the foregoing which, in the opinion of such attorney-
in-fact, may be of benefit to, in the best interest
of, or legally required by or for, the undersigned,
it being understood that the documents executed by
such attorney-in-fact on behalf of the undersigned
pursuant to this Limited Power of Attorney shall be
in such form and shall contain such information and
disclosure as such attorney-in-fact may approve in
such attorney-in-fact's discretion.
The undersigned hereby grants to each such
attorney-in-fact full power and authority to do and
perform any and every act and thing whatsoever
required, necessary or proper to be done in the
exercise of any of the rights and powers herein
granted, as fully to all intents and purposes as the
undersigned might or could do if personally present,
with full power of substitution or revocation, hereby
ratifying and confirming all that such attorney-in-
fact, or such attorney-in-fact's substitute or
substitutes, shall lawfully do or cause to be done by
virtue of this Limited Power of Attorney and the
rights and powers herein granted.
The undersigned acknowledges that the
foregoing attorneys-in-fact, in serving in such
capacity at the request and on the behalf of the
undersigned, are not assuming, nor is the Company
assuming, any of the undersigned's responsibilities
to comply with, or any liability for the failure to
comply with, any provision of Section 16 of the
Exchange Act.
This Limited Power of Attorney shall
remain in full force and effect until the undersigned
is no longer required to file Forms 3, 4 or 5 with
respect to the undersigned's holdings of and
transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed
writing delivered to the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has executed this
Limited Power of Attorney as of this 4th day of March,
2018.
Signed and acknowledged:
/s/____________________________________________
Markus Boehringer
