Statement of Changes in Beneficial Ownership (4)
09 November 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
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APPROVAL
OMB Number: 3235-0287
Estimated average burden
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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 * Yankie Lisa |
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)
Sr VP & Chief HR Officer |
(Last)
(First)
(Middle)
13320 BALLANTYNE CORPORATE PLACE |
3. Date of Earliest Transaction (MM/DD/YYYY)
11/5/2021
|
(Street)
CHARLOTTE, NC 28277
(City)
(State)
(Zip)
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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 |
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 (Dentsply Supplemental Savings
Plan) DSSP |
(1) |
11/5/2021 |
|
A |
|
3.9496 (2) |
|
(1) |
(1) |
Common Stock |
3.9496 |
$55.54 |
78.4259 |
D |
|
Explanation of
Responses: |
(1) |
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. |
(2) |
Comprised of phantom stock
acquired as a result of contribution to the Dentsply Supplemental
Savings Plan. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Yankie Lisa
13320 BALLANTYNE CORPORATE PLACE
CHARLOTTE, NC 28277 |
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|
Sr VP & Chief HR Officer |
|
Signatures
|
/s/ Dane Baumgardner, Attorney-In-Fact for Lisa
Yankie |
|
11/9/2021 |
**Signature of Reporting
Person |
Date |
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