SEC Form 4 · accession 0001590503-17-000067
Surgical Care Affiliates, Inc. · SCAI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Tom De Weerdt
Officer — Chief Financial Officer
Period of report
Mar 15, 2017
Accepted (ET)
Mar 17, 2017 · 1:03 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001411574
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Mar 15, 2017 | A | 105 | $48.13 | A | 37,783 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Options to Purchase Common StockF3 | $41.25 | holding | — | — | — | — | Mar 2, 2026 | Common Stock | 13,792 | 13,792 | D |
| Options to Purchase Common StockF4 | $56.64 | holding | — | — | — | — | Mar 2, 2027 | Common Stock | 9,214 | 9,214 | D |
Explanation of responses
- F1These shares were acquired under the Surgical Care Affiliates Teammate Stock Purchase Plan in transactions that were exempt under both Rule 16b-3(d) and Rule 16b-3(c).
- F2Includes 30,336 shares of Common Stock underlying restricted stock units ("RSUs") of the issuer, all of which are subject to time-based vesting. The RSUs vest on the following schedule and are settled on each applicable vesting date: 7,284 RSUs vesting on May 19, 2017, 4,609 RSUs vesting on March 2, 2018, 7,284 RSUs vesting on May 19, 2018, 4,609 RSUs vesting on March 2, 2019, 4,608 RSUs vesting on March 2, 2020 and 1,942 RSUs vesting on March 2, 2021.
- F3The option provides for vesting in equal annual installments on March 2, 2017, March 2, 2018, March 2, 2019 and March 2, 2020.
- F4The option provides for vesting in equal annual installments on March 2, 2018, March 2, 2019, March 2, 2020 and March 2, 2021.