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*
| C/O DENTSPLY SIRONA INC |
| 13320 BALLANTYNE CORPORATE PLACE |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
07/17/2023
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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 |
|
10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| SVP, CHRO |
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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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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
|
|---|
| 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)
|
6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| Remarks: |
|
| No securities are beneficially owned. |
|
/s/ Dane Baumgardner, Attorney-In-Fact for Andrea Frohning |
07/26/2023 |
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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 Richard Rosenzweig, 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 18th day of July 2023.
Signed and acknowledged:
/S/
Andrea Frohning
