-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, EWk3+vVpugyvz098SmKty0f5+H0WeJV+A966AO6lGtIoKM/1nNck9yEqG8m5q6nE ThK5e3Y9z7/Lzcb2zVS3cw== 0001012975-03-000010.txt : 20030114 0001012975-03-000010.hdr.sgml : 20030114 20030108110547 ACCESSION NUMBER: 0001012975-03-000010 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030108 FILED AS OF DATE: 20030108 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SCHEIN HENRY INC CENTRAL INDEX KEY: 0001000228 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-CATALOG & MAIL-ORDER HOUSES [5961] IRS NUMBER: 113136595 STATE OF INCORPORATION: DE FISCAL YEAR END: 1226 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-27078 FILM NUMBER: 03507223 BUSINESS ADDRESS: STREET 1: 135 DURYEA RD CITY: MELVILLE STATE: NY ZIP: 11747 BUSINESS PHONE: 6318425500X6867 MAIL ADDRESS: STREET 1: 135 DURYEA RD CITY: MELVILLE STATE: NY ZIP: 11747 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: LASKAWY PHILIP A CENTRAL INDEX KEY: 0001099296 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4/A BUSINESS ADDRESS: STREET 1: 9 CREAMER HILL RD CITY: GREENWICH STATE: CT ZIP: 06831 BUSINESS PHONE: 2036293727 MAIL ADDRESS: STREET 1: 1285 AVE. OF THE AMERICAS CITY: NEW YORK STATE: NY ZIP: 10019 4/A 1 e100104.txt ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0287 Expires: January 31, 2005 Estimated Average Burden Hours per response ....... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 [ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). (Print or Type Responses) - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Laskawy Philip A. - -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o Henry Schein, Inc. 135 Duryea Road - -------------------------------------------------------------------------------- (Street) Melville New York 11747 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Henry Schein, Inc. (HSIC) - -------------------------------------------------------------------------------- 3. IRS Social Security Number of Reporting Person, if an entity (Voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Year - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) June 10 2002 See explanation of responses. - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director 10% [_] Owner [_] Officer (give title below) [_] Other (specify below) - -------------------------------------------------------------------------------- 7. 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 ================================================================================
4. 5. 6. Securities Acquired (A) Amount of Owner- 3. or Disposed of (D) Securities ship Trans- (Instr. 3, 4 and 5) Benefi- Form: 7. 2. action ----------------------- cially Direct Nature of 1. Transaction Code Owned at End (D) or Indirect Title of Security Date (Instr. 8) (A) of Month Indirect Beneficial (Instr. 3) (Month/ ---------- or (Instr. 3 (I) Ownership Day/Year) Code V Amount (D) Price and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 05/28/2002 P 1,100 A $49.79 I By Spouse $0.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 05/28/2002 P 200 A $49.77 I By Spouse $0.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 05/28/2002 P 500 A $49.76 I By Spouse $0.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 05/28/2002 P 100 A $49.758 I By Spouse $0.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value 05/28/2002 P 100 A $49.759 2,000 I By Spouse $0.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
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) Please see reverse explanation of footnotes. (Over) SEC 1474 (7-96) 1 of 2 FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock $40.82 03/05/02 A V 10,000 (2) 03/05/12 Common 10,000 10,000 D Option (1) (right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: This amendment is to correct errors in columns 3 and 4 of Table I of the original filing. (1) Granted pursuant to the Henry Schein, Inc. 2001 Non-employee Director Stock Option Plan. (2) The option becomes exercisable in three equal annual installments beginning March 5, 2003. /s/ Philip A. Laskawy 1/6/03 -------------------------------------------- ------------ **Signature of Reporting Person Date **Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. 2 of 2 SEC 1474 (7-96) -----END PRIVACY-ENHANCED MESSAGE-----