SEC Form 5 · accession 0001209191-15-010378
HENRY SCHEIN INC · HSIC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Stanley M Bergman
Officer — Chairman, CEO · Director
Period of report
Dec 27, 2014
Accepted (ET)
Feb 6, 2015 · 4:45 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001000228
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock, par value $0.01 per shareF1 | Dec 10, 2014 | G | 20 | $0.00 | D | 157,912 | D | |
| Common Stock, par value $0.01 per shareF2 | holding | — | — | — | 560,451 | I | By Spouse | |
| Common Stock, par value $0.01 per shareF3 | holding | — | — | — | 66,008 | I | By Limited Liability Company | |
| Common Stock, par value $0.01 per share | holding | — | — | — | 4,395 | I | By 401(k) Plan |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Gift, not applicable.
- F2Represents (i) 560,339 shares held by the Bergman Family 2010 Trust 2, of which Marion Bergman, Stanley M. Bergman's wife, is a co-trustee and a beneficiary and (ii) 112 shares held by Mrs. Bergman.
- F3Represents shares held by a limited liability company. Stanley M. Bergman and Marion Bergman, Mr. Bergman's wife, each have voting and dispositive power with respect to the shares held by the limited liability company. Mr. and Mrs. Bergman disclaim beneficial ownership of the shares held by the limited liability company.