SEC Form 4 · accession 0001209191-15-028005
HENRY SCHEIN INC · HSIC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
James P Breslawski
Officer — Pres., HSI & CEO Global Dental · Director
Period of report
Mar 17, 2015
Accepted (ET)
Mar 19, 2015 · 6:48 pm EDT
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 | Mar 17, 2015 | S | 9,359 | $139.55 | D | 109,372 | D | |
| Common Stock, par value $0.01 per shareF2 | Mar 18, 2015 | S | 3,452 | $139.17 | D | 0 | I | by 401(k) plan |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SERP Phantom StockF4,F6,F3,F5 | — | Mar 18, 2015 | I | 4,728 | D | — | — | Common Stock, par value $0.01 per share | 4,728 | 0 | D |
Explanation of responses
- F1The price reflects a weighted average of sales made at prices ranging from $139.32 to $139.92 per share. The Reporting Person, upon request by the Securities and Exchange Commission staff, the Issuer, or a security holder of the Issuer, will provide full information regarding the number of shares sold at each separate price for this transaction.
- F2Represents the closing market price of the Issuer's common stock on March 18, 2015.
- F3The reported transaction on this line item of the Form 4 is a sale of Issuer common stock within the Issuer's Supplemental Executive Retirement Plan ("SERP") and the funds were reinvested in other investments.
- F4Represents the aggregate number of shares of phantom stock allocated to the reporting person under the SERP as of March 18, 2015 based on the closing price of a share of the Issuer's common stock on such date.
- F5The vested balance in the reporting person's SERP account is payable in cash only following the six-month anniverary of a termination of employment or within 30 days following a change in control of the Issuer. Subject to the terms of the SERP, the reporting person may change his hypothetical investment in the investment alternatives (including the Issuer's stock fund) to an alternative hypothetical investment at any time.
- F6The Reporting Person reinvested the cash value of 4,728 shares of SERP Phantom Stock held in the Issuer's SERP (valued based on the closing price of a share of the Issuer's common stock on March 18, 2015).