0001209191-18-009669.txt : 20180213
0001209191-18-009669.hdr.sgml : 20180213
20180213172127
ACCESSION NUMBER: 0001209191-18-009669
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171230
FILED AS OF DATE: 20180213
DATE AS OF CHANGE: 20180213
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BERGMAN STANLEY M
CENTRAL INDEX KEY: 0001008413
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-27078
FILM NUMBER: 18604954
MAIL ADDRESS:
STREET 1: C/O HENRY SCHEIN INC
STREET 2: 135 DURYEA ROAD
CITY: MELVILLE
STATE: NY
ZIP: 11747
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: HENRY SCHEIN INC
CENTRAL INDEX KEY: 0001000228
STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-MEDICAL, DENTAL & HOSPITAL EQUIPMENT & SUPPLIES [5047]
IRS NUMBER: 113136595
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1229
BUSINESS ADDRESS:
STREET 1: 135 DURYEA RD
CITY: MELVILLE
STATE: NY
ZIP: 11747
BUSINESS PHONE: 6318435500
MAIL ADDRESS:
STREET 1: 135 DURYEA RD
CITY: MELVILLE
STATE: NY
ZIP: 11747
FORMER COMPANY:
FORMER CONFORMED NAME: SCHEIN HENRY INC
DATE OF NAME CHANGE: 19950907
5
1
doc5.xml
FORM 5 SUBMISSION
X0306
5
2017-12-30
0
0
0
0001000228
HENRY SCHEIN INC
HSIC
0001008413
BERGMAN STANLEY M
C/O HENRY SCHEIN, INC.
135 DURYEA ROAD
MELVILLE
NY
11747
1
1
0
0
Chairman, CEO
Common Stock, par value $0.01 per share
2017-03-09
5
G
0
2588
0.00
D
115964
D
Common Stock, par value $0.01 per share
2017-03-21
5
G
0
205
0.00
D
115759
D
Common Stock, par value $0.01 per share
2017-04-18
5
G
0
310
0.00
D
115449
D
Common Stock, par value $0.01 per share
2017-05-25
5
G
0
75
0.00
D
115374
D
Common Stock, par value $0.01 per share
2017-06-02
5
G
0
30
0.00
D
115344
D
Common Stock, par value $0.01 per share
2017-09-11
5
G
0
982
0.00
D
229706
D
Common Stock, par value $0.01 per share
2017-09-12
5
G
0
608
0.00
D
229098
D
Common Stock, par value $0.01 per share
2017-09-22
5
G
0
311
0.00
D
228787
D
Common Stock, par value $0.01 per share
2017-09-25
5
G
0
300
0.00
D
228487
D
Common Stock, par value $0.01 per share
2017-10-18
5
G
0
648
0.00
D
227839
D
Common Stock, par value $0.01 per share
2017-11-17
5
G
0
375
0.00
D
227464
D
Common Stock, par value $0.01 per share
2017-12-01
5
G
0
377
0.00
D
227087
D
Common Stock, par value $0.01 per share
2017-12-19
5
G
0
8779
0.00
D
218308
D
Common Stock, par value $0.01 per share
2017-12-15
5
G
0
1600
0.00
D
973718
I
By Spouse
Common Stock, par value $0.01 per share
9001
I
By 401(k) plan
Gift, not applicable.
On 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.
Represents (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.
/s/ Jennifer Ferrero (as Attorney-in-Fact for Stanley M. Bergman)
2018-02-13