SEC Form 4 · accession 0001209191-17-015796
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
Feb 27, 2017
Accepted (ET)
Mar 1, 2017 · 4:04 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 | Feb 27, 2017 | A | 22,441 | $0.00 | A | 154,123 | D | |
| Common Stock, par value $0.01 per shareF2 | Feb 27, 2017 | F | 25,453 | $173.54 | D | 128,670 | D | |
| Common Stock, par value $0.01 per shareF3 | holding | — | — | — | 487,659 | I | By Spouse | |
| Common Stock, par value $0.01 per share | holding | — | — | — | 4,451 | I | By 401(k) plan |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Represents additional shares of the Issuer's common stock issued under the Henry Schein, Inc. 2013 Stock Incentive Plan, as may be amended from time to time, that vested on February 27, 2017 in connection with exceeding the performance target with respect to the reporting person's February 27, 2014 grant of performance-based restricted stock/units.
- 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 February 27, 2014 grant of performance-based restricted stock/units.
- 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.