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)
12/04/2012
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 12/04/2012 M 33,067 A $47.31 185,830 D
Common Stock, par value $0.01 per share 12/04/2012 S 33,067 D $80.62 (1) 152,763 D
Common Stock, par value $0.01 per share 12/04/2012 M 37,518 A $51.23 190,281 D
Common Stock, par value $0.01 per share 12/04/2012 S 37,518 D $80.62 (1) 152,763 D
Common Stock, par value $0.01 per share 12/04/2012 M 46,012 A $59.89 198,775 D
Common Stock, par value $0.01 per share 12/04/2012 S 46,012 D $80.62 (1) 152,763 D
Common Stock, par value $0.01 per share 12/05/2012 S 61,799 D $80.12 (2) 833,271 I By Spouse (3)
Common Stock, par value $0.01 per share 12/05/2012 S 701 D $80.73 (4) 832,570 I By Spouse (5)
Common Stock, par value $0.01 per share 04/10/2012 G V 740 D $0.00 (6) 831,830 I By Spouse (7)
Common Stock, par value $0.01 per share 04/20/2012 G V 350 D $0.00 (6) 831,480 I By Spouse (8)
Common Stock, par value $0.01 per share 04/23/2012 G V 12,500 D $0.00 (6) 818,980 I By Spouse (9)
Common Stock, par value $0.01 per share 05/18/2012 G V 679 D $0.00 (6) 818,301 I By Spouse (10)
Common Stock, par value $0.01 per share 08/09/2012 G V 350 D $0.00 (6) 817,951 I By Spouse (11)
Common Stock, par value $0.01 per share 08/15/2012 G V 3,000 D $0.00 (6) 814,951 I By Spouse (12)
Common Stock, par value $0.01 per share 09/17/2012 G V 330 D $0.00 (6) 814,621 I By Spouse (13)
Common Stock, par value $0.01 per share 10/02/2012 G V 330 D $0.00 (6) 814,291 I By Spouse (14)
Common Stock, par value $0.01 per share 11/13/2012 G V 2,020 D $0.00 (15) 812,271 I By Spouse (15)
Common Stock, par value $0.01 per share 11/15/2012 G V 1,995 D $0.00 (6) 810,276 I By Spouse (16)
Common Stock, par value $0.01 per share 11/16/2012 G V 665 D $0.00 (6) 809,611 I By Spouse (17)
Common Stock, par value $0.01 per share 11/29/2012 G V 129,236 D $0.00 (18) 680,375 I By Spouse (18)
Common Stock, par value $0.01 per share 10,000 I By Trust (19)
Common Stock, par value $0.01 per share 4,417 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
Stock Option (Right to Buy) (20) $47.31 12/04/2012 M 33,067 (21) 03/02/2016 Common Stock, par value $0.01 per share 33,067 $0.00 0 D
Stock Option (Right to Buy) (20) $51.23 12/04/2012 M 37,518 (22) 03/05/2017 Common Stock, par value $0.01 per share 37,518 $0.00 0 D
Stock Option (Right to Buy) (20) $59.89 12/04/2012 M 46,012 (23) 03/03/2018 Common Stock, par value $0.01 per share 46,012 $0.00 0 D
Explanation of Responses:
1. The price reflects a weighted average of sales made at prices ranging from $80.40 to $80.85 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. The price reflects a weighted average of sales made at prices ranging from $79.67 to $80.66 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.
3. Represents (i) 804,813 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) 28,458 shares held by Mrs. Bergman. The number of shares reported in the prior sentence reflects (i) a distribution of 5,400 shares made by the Bergman Family 2010 Trust 2 to Mrs. Bergman on April 10, 2012, (ii) a distribution of 12,500 shares made by the Bergman Family 2010 Trust 2 to Mrs. Bergman on April 23, 2012 and (iii) a distribution of 10,000 shares made by the Bergman Family 2010 Trust 2 to Mrs. Bergman on November 13, 2012.
4. The price reflects a weighted average of sales made at prices ranging from $80.69 to $80.79 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. Represents (i) 804,112 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) 28,458 shares held by Mrs. Bergman.
6. Gift, not applicable.
7. Represents (i) 804,112 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) 27,718 shares held by Mrs. Bergman.
8. Represents (i) 804,112 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) 27,368 shares held by Mrs. Bergman.
9. Represents (i) 804,112 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) 14,868 shares held by Mrs. Bergman.
10. Represents (i) 804,112 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) 14,189 shares held by Mrs. Bergman.
11. Represents (i) 804,112 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) 13,839 shares held by Mrs. Bergman.
12. Represents (i) 804,112 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) 10,839 shares held by Mrs. Bergman.
13. Represents (i) 804,112 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) 10,509 shares held by Mrs. Bergman.
14. Represents (i) 804,112 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) 10,179 shares held by Mrs. Bergman.
15. Represents (i) 804,112 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) 8,159 shares held by Mrs. Bergman.
16. Represents (i) 804,112 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) 6,164 shares held by Mrs. Bergman.
17. Represents (i) 804,112 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) 5,499 shares held by Mrs. Bergman.
18. Represents (i) 675,866 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) 4,509 shares held by Mrs. Bergman.
19. Represents 10,000 shares held by the Edward J. Bergman 2010 Trust for the benefit of one of Mr. Bergman's children and of which Mr. Bergman is the sole trsutee.
20. Acquired pursuant to the Issuer's 1994 Stock Incentive Plan, as amended.
21. The option vests in four equal installments on each of March 2, 2007, March 2, 2008, March 2, 2009 and March 2, 2010.
22. The option vests in four equal installments on each of March 5, 2008, March 5, 2009, March 5, 2010 and March 5, 2011.
23. The option vests in four equal installments on each of March 3, 2009, March 3, 2010, March 3, 2011 and March 3, 2012.
Remarks:
/s/ Stanley M. Bergman 12/06/2012
** 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).
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