SEC Form 4 · accession 0001209191-17-055195
HENRY SCHEIN INC · HSIC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Barry J Alperin
Director
Period of report
Sep 29, 2017
Accepted (ET)
Oct 3, 2017 · 4:50 pm EDT
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 | holding | — | — | — | 42,376 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Deferred Compensation Plan Phantom StockF3,F5,F2,F4 | — | Sep 29, 2017 | A | 146 | A | — | — | Common Stock, par value $0.01 per share | 146 | 9,804 | D |
Explanation of responses
- F1On September 14, 2017 the common stock of Henry Schein, Inc. split 2-for-1, resulting in the reporting person's ownership of 21,188 additional shares of common stock.
- F2Each share of phantom stock is the economic equivalent of one share of the Issuer's common stock.
- F3Represents 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.
- F4The balance in the reporting person's phantom share 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.
- F5Represents 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. The number of shares reported in Table II, Column 9, reflects the 2-for-1 stock split referred to in Footnote 1 of this Form 4.