SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
BERGMAN STANLEY M

(Last) (First) (Middle)
C/O HENRY SCHEIN, INC.
135 DURYEA ROAD

(Street)
MELVILLE NY 11747

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
HENRY SCHEIN INC [ HSIC ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chairman, CEO
3. Date of Earliest Transaction (Month/Day/Year)
12/12/2013
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock, par value $0.01 per share 12/12/2013 S 48,400 D $111.95(1) 113,590 I By Limited Liability Company(2)
Common Stock, par value $0.01 per share 12/12/2013 S 200 D $112.52 113,390 I By Limited Liability Company(2)
Common Stock, par value $0.01 per share 12/13/2013 S 10,700 D $111.55(3) 102,690 I By Limited Liability Company(2)
Common Stock, par value $0.01 per share 12/13/2013 S 18,700 D $111.98(4) 83,990 I By Limited Liability Company(2)
Common Stock, par value $0.01 per share 03/13/2013 G V 630 D $0.00(5) 631,186 I By Spouse(6)
Common Stock, par value $0.01 per share 03/22/2013 G V 1,945 D $0.00(5) 642,227 I By Spouse(7)
Common Stock, par value $0.01 per share 03/22/2013 G V 12,986 D $0.00(5) 163,770 D
Common Stock, par value $0.01 per share 03/25/2013 G V 1,110 D $0.00(5) 641,117 I By Spouse(8)
Common Stock, par value $0.01 per share 04/05/2013 G V 600 D $0.00(5) 640,517 I By Spouse(9)
Common Stock, par value $0.01 per share 05/23/2013 G V 8,365 D $0.00(5) 632,152 I By Spouse(10)
Common Stock, par value $0.01 per share 05/24/2013 G V 2,090 D $0.00(5) 630,062 I By Spouse(11)
Common Stock, par value $0.01 per share 05/28/2013 G V 385 D $0.00(5) 629,677 I By Spouse(12)
Common Stock, par value $0.01 per share 06/07/2013 G V 260 D $0.00(5) 629,417 I By Spouse(13)
Common Stock, par value $0.01 per share 08/07/2013 G V 300 D $0.00(5) 629,117 I By Spouse(14)
Common Stock, par value $0.01 per share 08/09/2013 G V 265 D $0.00(5) 628,852 I By Spouse(15)
Common Stock, par value $0.01 per share 08/13/2013 G V 100 D $0.00(5) 628,752 I By Spouse(16)
Common Stock, par value $0.01 per share 08/15/2013 G V 265 D $0.00(5) 628,487 I By Spouse(17)
Common Stock, par value $0.01 per share 08/19/2013 G V 600 D $0.00(5) 627,887 I By Spouse(18)
Common Stock, par value $0.01 per share 08/29/2013 G V 500 D $0.00(5) 627,387 I By Spouse(19)
Common Stock, par value $0.01 per share 09/04/2013 G V 200 D $0.00(5) 627,187 I By Spouse(20)
Common Stock, par value $0.01 per share 09/11/2013 G V 270 D $0.00(5) 626,917 I By Spouse(21)
Common Stock, par value $0.01 per share 09/13/2013 G V 30 D $0.00(5) 626,887 I By Spouse(22)
Common Stock, par value $0.01 per share 09/23/2013 G V 237 D $0.00(5) 626,650 I By Spouse(23)
Common Stock, par value $0.01 per share 10/10/2013 G V 95 D $0.00(5) 626,555 I By Spouse(24)
Common Stock, par value $0.01 per share 10/16/2013 G V 607 D $0.00(5) 625,948 I By Spouse(25)
Common Stock, par value $0.01 per share 11/12/2013 G V 1,045 D $0.00(5) 624,903 I By Spouse(26)
Common Stock, par value $0.01 per share 11/13/2013 G V 90 D $0.00(5) 624,813 I By Spouse(27)
Common Stock, par value $0.01 per share 11/18/2013 G V 185 D $0.00(5) 624,628 I By Spouse(28)
Common Stock, par value $0.01 per share 11/20/2013 G V 67 D $0.00(5) 624,561 I By Spouse(29)
Common Stock, par value $0.01 per share 4,403 I By 401(k) Plan
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. The price reflects a weighted average of sales made at prices ranging from $111.52 to $112.44 per share. The Reporting Person, upon request by the Securities and Exchange Commission staff, the issuer, or a security holder of the issuer, will provide full information regarding the number of shares sold at each separate price for this transaction.
2. Represents shares held by a limited liability company. Stanley M. Bergman and Marion Bergman, Mr. Bergman's wife, each have voting and dispositive power with respect to the shares held by the limited liability company.
3. The price reflects a weighted average of sales made at prices ranging from $111.32 to $111.69 per share. The Reporting Person, upon request by the Securities and Exchange Commission staff, the issuer, or a security holder of the issuer, will provide full information regarding the number of shares sold at each separate price for this transaction.
4. The price reflects a weighted average of sales made at prices ranging from $111.70 to $112.69 per share. The Reporting Person, upon request by the Securities and Exchange Commission staff, the issuer, or a security holder of the issuer, will provide full information regarding the number of shares sold at each separate price for this transaction.
5. Gift, not applicable.
6. Represents (i) 630,462 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) 724 shares held by Mrs. Bergman.
7. Represents (i) 626,162 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) 16,065 shares held by Mrs. Bergman. On March 22, 2013, (i) the Bergman Family 2010 Trust 2 transferred 4,300 shares to Mrs. Bergman and (ii) Mr. Bergman transferred 12,986 shares to Mrs. Bergman (reported in line 7 of this Form 4), each of which is reflected in the preceding sentence.
8. Represents (i) 626,162 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) 14,955 shares held by Mrs. Bergman.
9. Represents (i) 639,148 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) 1,369 shares held by Mrs. Bergman. On March 26, 2013, Mrs. Bergman transferred 12,986 shares to the Bergman Family 2010 Trust 2 which is reflected in the numbers in the preceding sentence.
10. Represents (i) 627,642 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) 4,510 shares held by Mrs. Bergman. Additionally, on May 23, 2013, the Bergman Family 2010 Trust 2 transferred 11,506 shares to Mrs. Bergman which is reflected in the numbers in the preceding sentence.
11. Represents (i) 627,642 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) 2,420 shares held by Mrs. Bergman.
12. Represents (i) 627,642 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) 2,035 shares held by Mrs. Bergman.
13. Represents (i) 627,642 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) 1,775 shares held by Mrs. Bergman.
14. Represents (i) 627,642 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) 1,475 shares held by Mrs. Bergman.
15. Represents (i) 627,642 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) 1,210 shares held by Mrs. Bergman.
16. Represents (i) 627,642 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) 1,110 shares held by Mrs. Bergman.
17. Represents (i) 627,642 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) 845 shares held by Mrs. Bergman.
18. Represents (i) 627,642 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) 245 shares held by Mrs. Bergman.
19. Represents (i) 624,142 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) 3,245 shares held by Mrs. Bergman. On May 29, 2013, the Bergman Family 2010 Trust 2 transferred 3,500 shares to Mrs. Bergman which is reflected in the numbers in the preceding sentence.
20. Represents (i) 624,142 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) 3,045 shares held by Mrs. Bergman.
21. Represents (i) 624,142 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) 2,775 shares held by Mrs. Bergman.
22. Represents (i) 624,142 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) 2,745 shares held by Mrs. Bergman.
23. Represents (i) 624,142 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) 2,508 shares held by Mrs. Bergman.
24. Represents (i) 624,142 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) 2,413 shares held by Mrs. Bergman.
25. Represents (i) 624,142 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) 1,806 shares held by Mrs. Bergman.
26. Represents (i) 624,142 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) 761 shares held by Mrs. Bergman.
27. Represents (i) 624,142 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) 671 shares held by Mrs. Bergman.
28. Represents (i) 624,142 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) 486 shares held by Mrs. Bergman.
29. Represents (i) 624,142 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) 419 shares held by Mrs. Bergman.
Remarks:
/s/ Stanley M. Bergman 12/16/2013
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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