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
|
| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person*
| C/O ALIGN TECHNOLOGY, INC. |
| 410 NO. SCOTTSDALE RD., SUITE 1300 |
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year)
12/05/2023
|
3. Issuer Name and Ticker or Trading Symbol
ALIGN TECHNOLOGY INC
[ ALGN ]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
|
10% Owner |
|
Officer (give title below) |
|
Other (specify below) |
|
|
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)
|
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 |
| Explanation of Responses: |
| Remarks: |
|
| No securities are beneficially owned. |
|
/s/ Julie Ann Coletti Attorney-in-Fact for Kevin T. Conroy |
12/07/2023 |
|
** 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. |
LIMITED POWER OF ATTORNEY - SECURITIES LAW COMPLIANCE
The undersigned, as a director of Align Technology, Inc.
(the "Company"), hereby constitutes and appoints John Morici
and Julie Ann Coletti, and each of them, the undersigned's
true and lawful attorney-in-fact and agent to complete
and execute such Forms 144, Forms 3, 4 and 5 and
other forms as such attorney shall in his or her discretion
determine to be required or advisable pursuant to Rule 144
promulgated under the Securities Act of 1933, as amended,
Section 16 of the Securities Exchange Act of 1934,
as amended, and the rules and regulations promulgated
thereunder, or any successor laws and regulations,
as a consequence of the undersigned's ownership,
acquisition or disposition of securities of the Company,
and to do all acts necessary in order to file such forms with the
Securities and Exchange Commission, any securities exchange or
national association, the Company and such other person or
agency as the attorney shall deem appropriate. The undersigned
hereby ratifies and confirms all that said attorneys-in-fact
and agents shall do or cause to be done by virtue hereof.
This Limited Power of Attorney shall remain in full force and
effect until the undersigned is no longer required to file
Forms 3, 4 and 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 writing
delivered to the foregoing attorneys-in-fact.
This Limited Power of Attorney is executed at Madison, WI,
as of the date set forth below.
/s/ Kevin Conroy
Kevin Conroy
Dated: 12.04.2023
Witness:
/s/ Julie Rasmussen
Julie Rasmussen
Dated: 12.04.2023
