SEC Form 4 · accession 0001209191-16-105623
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
Mar 1, 2016
Accepted (ET)
Mar 3, 2016 · 5:52 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 | Jan 7, 2016 | G | 467 | $0.00 | D | 152,459 | D | |
| Common Stock, par value $0.01 per shareF1 | Jan 13, 2016 | G | 171 | $0.00 | D | 152,288 | D | |
| Common Stock, par value $0.01 per shareF1 | Feb 11, 2016 | G | 172 | $0.00 | D | 152,116 | D | |
| Common Stock, par value $0.01 per shareF1 | Feb 25, 2016 | G | 10 | $0.00 | D | 152,106 | D | |
| Common Stock, par value $0.01 per share | Mar 1, 2016 | D | 1,042 | $0.00 | D | 151,064 | D | |
| Common Stock, par value $0.01 per shareF2 | Mar 1, 2016 | F | 15,126 | $170.16 | D | 135,938 | D | |
| Common Stock, par value $0.01 per shareF3 | holding | — | — | — | 520,416 | I | By Spouse | |
| Common Stock, par value $0.01 per shareF4 | holding | — | — | — | 34,608 | I | By Limited Liability Co. | |
| Common Stock, par value $0.01 per share | holding | — | — | — | 4,409 | I | By 401(k) plan |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Gift, not applicable.
- F2Represents the surrender of shares to the Issuer to satisfy the reporting person's tax withholding obligation upon the vesting of the reporting person's March 1, 2013 grant of performance-based restricted stock units.
- F3Represents (i) 520,284 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) 132 shares held by Mrs. Bergman.
- F4Represents 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.