0001209191-21-057780.txt : 20210927 0001209191-21-057780.hdr.sgml : 20210927 20210927161937 ACCESSION NUMBER: 0001209191-21-057780 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210924 FILED AS OF DATE: 20210927 DATE AS OF CHANGE: 20210927 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ALI MOHAMAD CENTRAL INDEX KEY: 0001580247 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27078 FILM NUMBER: 211281949 MAIL ADDRESS: STREET 1: 2 AVENUE DE LAFAYETTE CITY: BOSTON STATE: MA ZIP: 02111 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: 1225 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 2021-09-24 0 0001000228 HENRY SCHEIN INC HSIC 0001580247 ALI MOHAMAD C/O HENRY SCHEIN, INC. 135 DURYEA ROAD MELVILLE NY 11747 1 0 0 0 Common Stock, par value $0.01 per share 3790 D Deferred Compensation Plan Phantom Stock 2021-09-24 4 A 0 344 0.00 A Common Stock, par value $0.01 per share 344 893 D Each share of phantom stock is the economic equivalent of one share of the Issuer's common stock. Represents the number of shares of phantom stock credited to the reporting person's phantom stock account pursuant to the Issuer's Non-Employee Director Deferred Compensation Plan (the "Plan"), representing an exempt transaction under the Plan. The number of shares of phantom stock credited to the reporting person's phantom stock account is determined by dividing the amount of deferred eligible director fees by the closing price of a share of Issuer common stock on the award date. The balance in the reporting person's phantom share account is distributed to the reporting person in Issuer common stock following the termination of the reporting person's directorship, the reporting person's death or disability or a change of control of the Issuer. Represents the aggregate number of shares of phantom stock allocated to the reporting person under the Plan as of the award date based on the closing price of a share of the Issuer's common stock on the award date. /s/ Jennifer Ferrero (as Attorney-in-Fact for Mohamad Ali) 2021-09-27