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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 5
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
[_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
[_] Form 3 Holdings Reported
[_] Form 4 Transactions Reported
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1. Name and Address of Reporting Person*
Alperin Barry J.
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(Last) (First) (Middle)
c/o Henry Schein, Inc.
135 Duryea Rd.
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(Street)
Melville New York 11747
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Henry Schein, Inc. (HSIC)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
Fiscal year ended December 28, 2002
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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7. Individual or Joint/Group Filing
(Check applicable line)
[X] Form filed by one Reporting Person
[_] Form filed by more than one Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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5. 6.
4. Amount of Owner-
2A. Securities Acquired (A) or Securities ship 7.
Deemed Disposed of (D) Beneficially Form: Nature of
2. Execution (Instr. 3, 4 and 5) Owned at End Direct Indirect
1. Title of Transaction Date, if 3. ----------------------------- of Issuer's (D) or Bene-
Security Date any Transaction (A) Fiscal Year Indirect ficial
(Instr. 3) (Month/ (Month/ Code Amount or Price (Instr. 3 (I) Ownership
Day/Year) Day/Year) (Instr. 8) (D) and 4) (Instr.4) (Instr.4)
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* If the form is filed by more than one Reporting Person, see Instruction
4(b)(v).
(Over)
SEC 2270 (9-02)
Page 1 of 2
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or 3A. Derivative 6. of Underlying 8. ities Secur- of
Exer- Deemed Securities Date Securities Price Bene- ity: In-
cise 3. Execu- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- tion 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Date, if Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date any action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Stock Option
(right to $40.82 3/5/02 A 5,000 (3) 3/5/12 Common 5,000 5,000 D
buy)(1) Stock
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Stock Option
(right to $40.82 3/5/02 A 2,500 (3) 3/5/12 Common
buy)(2) Stock 2,500 2,500 D
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Stock Option
(right to $48.81 6/5/02 A 2,500 (3) 6/5/12 Common
buy)(1) Stock 2,500 2,500 D
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Explanation of Responses:
(1) Acquired pursuant to the Issuer's 1996 Non-Employee Director Stock Option
Plan.
(2) Acquired pursuant to the Issuer's 2001 Non-Employee Director Stock Option
Plan.
(3) Pursuant to the terms of the stock option agreement between the Issuer and
the Reporting Person, the option becomes exercisable in three (3) equal annual
installments beginning on the first (1st) anniversary of the grant date
specified in Column 3.
/s/ Barry J. Alperin February 11, 2003
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**Signature of Reporting Person Date
**Intentional misstatements or omissions of facts constitute Federal Criminal
Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this form, one of which must be manually signed.
If space provided is insufficient, see Instruction 6 for procedure.
SEC 2270 (9-02)
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