SEC Form 4 · accession 0001209191-17-000819

HENRY SCHEIN INC · HSIC

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Dec 30, 2016

Accepted (ET)

Jan 4, 2017 · 4:08 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 share	holding	—	—		—	4,190	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Deferred Compensation Plan Phantom Stock^F2,F4,F1,F3	—	Dec 30, 2016	A	149	A	—	—	Common Stock, par value $0.01 per share	149	1,246	D

F1Each share of phantom stock is the economic equivalent of one share of the Issuer's common stock.
F2Represents the number of shares of phantom stock credited to the reporting person's phantom stock account pursuant to the Issuer's Non-Employee Director Deferred Compensation Plan (the "Plan"), representing an exempt transaction under the Plan. The number of shares of phantom stock credited to the reporting person's phantom stock account is determined by dividing the amount of deferred eligible director fees by the closing price of a share of Issuer common stock on the award date.
F3The balance in the reporting person's phantom stock account is distributed to the reporting person in Issuer common stock following the termination of the reporting person's directorship, the reporting person's death or disability or a change of control of the Issuer.
F4Represents the aggregate number of shares of phantom stock allocated to the reporting person under the Plan as of the award date based on the closing price of a share of the Issuer's common stock on the award date.