0001209191-19-017451.txt : 20190306 0001209191-19-017451.hdr.sgml : 20190306 20190306172459 ACCESSION NUMBER: 0001209191-19-017451 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190304 FILED AS OF DATE: 20190306 DATE AS OF CHANGE: 20190306 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Siegel Walter CENTRAL INDEX KEY: 0001342060 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27078 FILM NUMBER: 19663512 MAIL ADDRESS: STREET 1: C/O STANDARD MICROSYSTEMS CORPORATION STREET 2: 80 ARKAY DRIVE CITY: HAUPPAUGE STATE: NY ZIP: 11788 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-03-04 0 0001000228 HENRY SCHEIN INC HSIC 0001342060 Siegel Walter C/O HENRY SCHEIN, INC. 135 DURYEA ROAD MELVILLE NY 11747 0 1 0 0 Senior VP & General Counsel Common Stock, par value $0.01 per share 2019-03-04 4 D 0 2404 0.00 D 41606 D Common Stock, par value $0.01 per share 2019-03-04 4 F 0 843 59.76 D 40763 D Common Stock, par value $0.01 per share 2019-03-05 4 A 0 12008 0.00 A 52771 D Represents the surrender of shares to the issuer to satisfy the reporting person's tax withholding obligation upon the vesting of the reporting person's March 4, 2016 grant of performance-based restricted stock/units. Grant of restricted stock units (RSU) pursuant to the Issuer's 2013 Stock Incentive Plan. Subject to certain exceptions, 65% will vest subject to (x) Issuer's achievement of a specified performance goal and (y) reporting person's continued perf. of services for the Issuer. 35% will vest subject to (x) passage of a specified period of time and (y) reporting person's continued perf. of services for the Issuer. With respect to the performance-based RSU, if the continued service requirement is satisfied and achievement of the performance goal (x) exceeds 100% of target, the Issuer may issue additional vested shares of common stock in an amount that corresponds to the incremental percentage of the performance goal achieved in excess of 100% of target or (y) is less than 100% of target, the reporting person will surrender to the Issuer shares of common stock in an amount that corresponds to the incremental percentage of the performance goal achieved that is below 100% of target (shortfall). /s/ Jennifer Ferrero (as Attorney-in-Fact for Walter Siegel) 2019-03-06