0001209191-23-018970.txt : 20230315 0001209191-23-018970.hdr.sgml : 20230315 20230315174420 ACCESSION NUMBER: 0001209191-23-018970 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230313 FILED AS OF DATE: 20230315 DATE AS OF CHANGE: 20230315 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BERGMAN STANLEY M CENTRAL INDEX KEY: 0001008413 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-27078 FILM NUMBER: 23736389 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: 1231 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 2023-03-13 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 2023-03-13 4 G 0 5773 0.00 D 281531 D Common Stock, par value $0.01 per share 2023-03-14 4 G 0 14080 0.00 D 242451 D Common Stock, par value $0.01 per share 2023-03-15 4 G 0 3861 0.00 D 214732 D Common Stock, par value $0.01 per share 2023-03-15 4 J 0 13800 0.00 D 498184 I By Spouse Common Stock, par value $0.01 per share 9500 I by 401(k) plan Gift, not applicable. The amount reflected in Column 5 includes the transfer of 25,000 shares from the Bergman Family Trust #2 to Stanley M. Bergman on March 13, 2023. The amount reflected in Column 5 includes the transfer of 25,000 shares from Stanley M. Bergman to the Bergman Family Trust #2 on March 14, 2023. The amount reflected in Column 5 reflects the transfer on March 15, 2023 of (i) 11,929 shares from Stanley M. Bergman to the Edward J. Bergman 2011 GST Trust, of which Mrs. Bergman, Stanley M. Bergman's wife, is a co-trustee and (ii) 11,929 shares from Stanley M. Bergman to the Paul I. Bergman 2011 GST Trust, of which Mrs. Bergman is a co-trustee. The transfer of shares in this transaction represents the decanting of the shares by the Bergman Family 2010 Trust #2 to a related trust. Represents (i) 144,736 shares held by the Bergman Family 2010 Trust #2, of which Mrs. Bergman, is a co-trustee and a beneficiary; (ii) 180 shares held by Mrs. Bergman; (iii) 329,410 shares held by the Bergman Family 2010 Trust #2, LLC, of which Mrs. Bergman is a manager; and (iv) 23,858 shares held by the SBMB GST Trusts Partners LLC, of which Mrs. Bergman is a manager. The amount in Footnote 6 includes the transfer of 11,929 shares from Stanley M. Bergman to the Edward J. Bergman 2011 GST Trust and 11,929 shares from Stanley M. Bergman to the Paul I. Bergman 2011 GST Trust both on March 15, 2023, and the subsequent contribution of those 23,858 shares to the SBMB GST Trusts Partners LLC on March 15, 2023. Reflects the reporting person's interest in equivalent shares of Henry Schein common stock held by the unitized stock fund in the Henry Schein, Inc. 401(k) Savings Plan (the "Plan"). The unitized stock fund consists of Henry Schein common stock and cash or cash equivalents. The number of shares attributed to the reporting person as a participant in the Plan and expressed as equivalent shares has been calculated based on the closing price of Henry Schein common stock on March 13, 2023. /s/ Jennifer Ferrero (as Attorney-in-Fact for Stanley M. Bergman) 2023-03-15