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