SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
PICKRELL FLOYD W

(Last) (First) (Middle)
1717 WEST COLLINS AVENUE

(Street)
ORANGE CA 92867

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
SYBRON DENTAL SPECIALTIES INC [ SYD ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
3. Date of Earliest Transaction (Month/Day/Year)
05/25/2004
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction 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 05/25/2004 05/26/2004 M 20,000 A $13.8765 127,768 D
Common Stock 05/25/2004 05/26/2004 S(1) 17,900 D $28 109,868 D
Common Stock 05/25/2004 05/26/2004 S 1,200 D $28.01 108,668 D
Common Stock 05/25/2004 05/26/2004 S 500 D $28.02 108,168 D
Common Stock 05/25/2004 05/26/2004 S 300 D $28.03 107,868 D
Common Stock 05/25/2004 05/26/2004 S 100 D $29.05 107,768 D
Common Stock 20,000 I Floyd W. Pickrell Jr. & Yvette Diuri Pickrell Trustees of the Pickrell Rev. Lvg. Trust
Common Stock 884(2) I 401(k)
Common Stock 1,200 I Floyd W. Pickrell Jr. & Yvette Diuri Pickrell Trustees of the Allison Pickrell Irrev. Trust
Common Stock 150 I Floyd W. Pickrell Jr. & Yvette Diuri Pickrell Trustees of the Melanie Pickrell Irrev. Trust
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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
Employee Stock Option (right to buy) $13.8765 05/25/2004 05/26/2004 M 20,000 (3) 04/27/2008 Common Stock 20,000 $0 800,499 D
Employee Stock Option (right to buy) $15.4375 (4) 12/14/2010 Common Stock 496,278 496,278 D
Explanation of Responses:
1. The sales reported in this Form 4 were effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on April 28, 2004.
2. Includes any shares of common stock acquired under the 401(k) plan in transactions exempt from Section 16(b) pursuant to Rule 16b-3(c) since the date as of which information was given in the reporting person's most recent previous report. The number of shares in the plan attributable to any one participant varies with the price of the common stock. The information in this report is based on a plan statement dated as of March 31, 2004.
3. This option vested in four equal annual installments beginning on 04/27/99.
4. This option vests in four equal annual installments beginning on 12/14/01.
Remarks:
Gisella Brett Attorney-in-Fact 05/27/2004
** 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 4 (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.