Statement of Changes in Beneficial Ownership (4)
12 Oktober 2021 - 10:44PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
|
OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
|
Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
|
|
| 1. Name
and Address of Reporting Person * Ebling Keith J. |
2. Issuer Name and Ticker or Trading
Symbol DENTSPLY SIRONA Inc. [ XRAY ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)_____
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
EVP, Secretary & Gen. Counsel |
|
(Last)
(First)
(Middle)
13320 BALLANTYNE CORPORATE PLACE |
3. Date of Earliest Transaction (MM/DD/YYYY)
10/8/2021
|
|
(Street)
CHARLOTTE, NC 28277
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line) _X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
|
Code |
V |
Amount |
(A) or (D) |
Price |
|
Common Stock |
10/8/2021 |
|
A |
|
25.705 (1) |
A |
$60.01 |
46517.662 |
D |
|
|
Common Stock |
|
|
|
|
|
|
|
203 |
I |
By Reporting Person's Trust |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. Code
(Instr. 8) |
5. Number of Derivative Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date |
7. Title and Amount of Securities Underlying
Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of derivative Securities Beneficially
Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr.
4) |
|
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
|
Phantom Stock (Supplemental Executive Retirement
Plan) SERP |
(2) |
10/8/2021 |
|
A |
|
9.8624 (3) |
|
(2) |
(2) |
Common Stock |
9.8624 |
$58.46 |
5250.902 |
D |
|
| Explanation of
Responses: |
| (1) |
Represents dividends on
restricted stock units (RSUs) awarded to the Reporting Person in
the form of additional RSUs and are subject to the same vesting
terms as the underlying awards. The dividends vest simultaneously
with the RSUs to which they relate. Each RSU converts to common
stock on a 1:1 basis. |
| (2) |
Each share of phantom stock
is the economic equivalent of one share of common stock. The shares
of phantom stock become payable in common stock upon the reporting
persons termination of employment. |
| (3) |
Comprised of phantom stock
acquired as a result of accrued dividends. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
Ebling Keith J.
13320 BALLANTYNE CORPORATE PLACE
CHARLOTTE, NC 28277 |
|
|
EVP, Secretary & Gen. Counsel |
|
Signatures
|
|
Dane Baumgardner, Attorney-In-Fact for Keith J.
Ebling |
|
10/12/2021 |
| **Signature of Reporting
Person |
Date |
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