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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1. Name and Address of Reporting Person*
CRAWFORD SALLY

(Last) (First) (Middle)
10225 WESTMOOR DRIVE

(Street)
WESTMINSTER CO 80021

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/01/2022
3. Issuer Name and Ticker or Trading Symbol
ZimVie Inc. [ ZIMV ]
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)
Common Stock 127(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
Explanation of Responses:
1. Reflects shares received in the pro rata spinoff distribution of shares of common stock of ZimVie Inc., a Delaware corporation, by Zimmer Biomet Holdings, Inc., a Delaware corporation ("Zimmer Biomet"), on March 1, 2022, in respect of shares of common stock of Zimmer Biomet held by the Reporting Person as of the record date for the distribution.
Remarks:
See Exhibit 24 - Power of Attorney.
/s/ Heather Kidwell, Attorney-in-Fact for Sally Crawford 03/01/2022
** 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.
                                POWER OF ATTORNEY

        The undersigned constitutes and appoints Heather Kidwell and David
Harmon, or any of them acting singly, as the undersigned's true and lawful
attorneys-in-fact and agents, with full power of substitution and
resubstitution, for the undersigned and in the undersigned's name, place and
stead, to:

        1.    sign any and all Securities and Exchange Commission (the
"SEC") statements of beneficial ownership of securities of ZimVie Inc. (the
"Company") on Schedule 13D as required under Section 13 and Forms 3, 4 and 5 as
required under Section 16(a) of the Securities Exchange Act of 1934, as
amended, and any amendments thereto, and to file the same with all exhibits
thereto, and other documents in connection therewith, with the SEC, the Company
and any stock exchange on which any of the Company's securities are listed,
granting unto said attorneys-in-fact and agents, and each of them, full power
and authority to do and perform each act and thing requisite and necessary to
be done under said Section 13 and Section 16(a), as fully and to all intents
and purposes as the undersigned might or could do in person, hereby ratifying
and confirming all that said attorneys-in-fact and agents, and each of them,
may lawfully do or cause to be done by virtue hereof.

        A copy of this power of attorney shall be filed with the SEC. The
authorization set forth above shall continue in full force and effect until the
undersigned revokes such authorization by written instructions to the
attorneys-in-fact.

        The authority granted hereby shall in no event be deemed to impose or
create any duty on behalf of the attorneys-in-fact with respect to the
undersigned's obligations to file Schedule 13Ds and Forms 3, 4 and 5 with the
SEC.

Dated: January 26, 2022

                                   By: /s/ Sally Crawford
                                   -------------------------------
                                   Name: Sally Crawford