SEC Form 5 · accession 0001209191-17-009538
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 31, 2016
Accepted (ET)
Feb 10, 2017 · 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 11, 2016 | G | 321 | $0.00 | D | 487,824 | I | By Spouse |
| Common Stock, par value $0.01 per shareF1,F3 | Nov 23, 2016 | G | 165 | $0.00 | D | 487,659 | I | By Spouse |
| Common Stock, par value $0.01 per share | holding | — | — | — | 173,928 | D | ||
| Common Stock, par value $0.01 per share | holding | — | — | — | 4,447 | I | By 401(k) |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Gift, not applicable.
- F2Represents (i) 487,642 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) 182 shares held by Mrs. Bergman. On November 11, 2016 the Bergman Family Trust 2 transferred 350 shares to Mrs. Bergman which is reflected in the number in Column 5 of this line item.
- F3Represents (i) 487,642 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) 17 shares held by Mrs. Bergman.