SEC Form 4 · accession 0001209191-16-150166
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
Nov 11, 2016
Accepted (ET)
Nov 15, 2016 · 4:19 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,F2 | Nov 9, 2016 | G | 334 | $0.00 | D | 488,305 | I | By Spouse |
| Common Stock, par value $0.01 per shareF1,F3 | Nov 10, 2016 | G | 160 | $0.00 | D | 488,145 | I | By Spouse |
| Common Stock, par value $0.01 per shareF4,F5 | Nov 11, 2016 | S | 8,605 | $155.66 | D | 6,809 | I | By Limited Liability Co. |
| Common Stock, par value $0.01 per shareF6,F5 | Nov 11, 2016 | S | 6,809 | $156.59 | D | 0 | I | By Limited Liability Co. |
| Common Stock, par value $0.01 per share | holding | — | — | — | 173,928 | D | ||
| Common Stock, par value $0.01 per share | holding | — | — | — | 4,435 | I | By 401(k) plan |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Gift, not applicable.
- F2Represents (i) 487,992 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) 313 shares held by Mrs. Bergman.
- F3Represents (i) 487,992 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) 153 shares held by Mrs. Bergman.
- F4The price reflects a weighted average of sales made at prices ranging from $155.17 to $156.00 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.
- F5Represents 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.
- F6The price reflects a weighted average of sales made at prices ranging from $156.24 to $156.86 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.