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*
Mitsdoerffer Stephan

(Last) (First) (Middle)
SIRONA DENTAL SYSTEMS, INC.
30-30 47TH AVENUE, SUITE 500

(Street)
LONG ISLAND CITY NY 11101

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/02/2014
3. Issuer Name and Ticker or Trading Symbol
SIRONA DENTAL SYSTEMS, INC. [ SIRO ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Accounting Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 Beneficially Owned
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 9,448(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Options(Right to buy) (2) 11/20/2022 Common Stock 1,000 $62.2 D
Options(Right to buy) (3) 11/26/2023 Common Stock 1,200 $67.59 D
Explanation of Responses:
1. The total directly held by the reporting person includes RSU's, PSU's and MSU's.
2. Stock options shall vest as follows: 1/4 on 11/20/2013, 1/4 on 11/20/2014, 1/4 on 11/20/2015 and the final 1/4 on 11/20/2016.
3. Stock options shall vest as follows: 1/4 on 11/26/2014, 1/4 on 11/26/2015, 1/4 on 11/26/2016 and the final 1/4 on 11/26/2017.
Remarks:
Exhibit List - Exhibit 24, Power of Attorney
Stephan Mitsdorffer, by Michael Friedlander, Attorney 06/06/2014
** 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.