SEC Form 4 · accession 0001209191-17-019344
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 6, 2017
Accepted (ET)
Mar 8, 2017 · 5:27 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 | Mar 1, 2017 | G | 26,614 | $0.00 | D | 102,056 | D | |
| Common Stock, par value $0.01 per shareF1 | Mar 2, 2017 | G | 901 | $0.00 | D | 101,155 | D | |
| Common Stock, par value $0.01 per shareF1 | Mar 3, 2017 | G | 1,726 | $0.00 | D | 99,429 | D | |
| Common Stock, par value $0.01 per shareF1 | Mar 6, 2017 | G | 1,149 | $0.00 | D | 98,280 | D | |
| Common Stock, par value $0.01 per shareF2 | Mar 6, 2017 | A | 20,479 | $0.00 | A | 118,759 | D | |
| Common Stock, par value $0.01 per shareF1 | Mar 7, 2017 | G | 207 | $0.00 | D | 118,552 | D | |
| Common Stock, par value $0.01 per shareF3 | holding | — | — | — | 487,659 | I | By Spouse | |
| Common Stock, par value $0.01 per share | holding | — | — | — | 4,452 | I | By 401(k) plan |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Gift, not applicable.
- F2Grant of performance-based restricted stock units (RSUs) pursuant to the Issuer's 2013 Stock Incentive Plan. Subject to certain exceptions, such performance-based RSUs will vest subject to (x) Issuer's achievement of a specified performance goal and (y) reporting person's continued performance of services for the Issuer. If the continued service requirement is satisfied and achievement of the performance goal (x) exceeds 100% of target, the Issuer may issue additional vested shares of common stock in an amount that corresponds to the incremental percentage of the performance goal achieved in excess of 100% of target or (y) is less than 100% of target, the reporting person will surrender to the Issuer shares of common stock in an amount that corresponds to the incremental percentage of the performance goal achieved that is below 100% of target (i.e., shortfall).
- 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.