SEC Form 5 · accession 0001209191-18-009669
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 30, 2017
Accepted (ET)
Feb 13, 2018 · 5:21 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 9, 2017 | G | 2,588 | $0.00 | D | 115,964 | D | |
| Common Stock, par value $0.01 per shareF1 | Mar 21, 2017 | G | 205 | $0.00 | D | 115,759 | D | |
| Common Stock, par value $0.01 per shareF1 | Apr 18, 2017 | G | 310 | $0.00 | D | 115,449 | D | |
| Common Stock, par value $0.01 per shareF1 | May 25, 2017 | G | 75 | $0.00 | D | 115,374 | D | |
| Common Stock, par value $0.01 per shareF1 | Jun 2, 2017 | G | 30 | $0.00 | D | 115,344 | D | |
| Common Stock, par value $0.01 per shareF1,F2 | Sep 11, 2017 | G | 982 | $0.00 | D | 229,706 | D | |
| Common Stock, par value $0.01 per shareF1 | Sep 12, 2017 | G | 608 | $0.00 | D | 229,098 | D | |
| Common Stock, par value $0.01 per shareF1 | Sep 22, 2017 | G | 311 | $0.00 | D | 228,787 | D | |
| Common Stock, par value $0.01 per shareF1 | Sep 25, 2017 | G | 300 | $0.00 | D | 228,487 | D | |
| Common Stock, par value $0.01 per shareF1 | Oct 18, 2017 | G | 648 | $0.00 | D | 227,839 | D | |
| Common Stock, par value $0.01 per shareF1 | Nov 17, 2017 | G | 375 | $0.00 | D | 227,464 | D | |
| Common Stock, par value $0.01 per shareF1 | Dec 1, 2017 | G | 377 | $0.00 | D | 227,087 | D | |
| Common Stock, par value $0.01 per shareF1 | Dec 19, 2017 | G | 8,779 | $0.00 | D | 218,308 | D | |
| Common Stock, par value $0.01 per shareF1,F2,F3 | Dec 15, 2017 | G | 1,600 | $0.00 | D | 973,718 | I | By Spouse |
| Common Stock, par value $0.01 per shareF2 | holding | — | — | — | 9,001 | I | By 401(k) plan |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Gift, not applicable.
- F2On September 14, 2017, the common stock of Henry Schein, Inc. split two-for-one (for shares held on the record date of September 1, 2017), resulting in the reporting person's ownership of additional shares of common stock.
- F3Represents (i) 973,684 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) 34 shares held by Mrs. Bergman.