SEC Form 4 · accession 0000899243-16-027908

USMD Holdings, Inc. · USMD

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Dec 15, 2015

Accepted (ET)

Aug 23, 2016 · 4:47 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001507881

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock ($.01 par value)^F1	Dec 15, 2015	A	990	$7.65	A	30,223	D
Common Stock ($.01 par value)^F2	Aug 19, 2016	J	310	$4.69	A	39,825	I	Indirectly held through UANT Ventures, L.P.

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Right to purchaser^F3	$23.37	holding	—	—	—	Sep 1, 2014	—	5% Convertible Subordinated Notes Due 2019	34,498	34,498	I

F1Represents stock compensation issued pursuant to the 2010 USMD Holdings, Inc. Equity Compensation Plan and granted to Dr. Dickey in lieu of compensation of $7,574 for his services as a physician employed by an affiliate of the issuer.
F2Dr. Dickey purchased additional partnership interests in UANT Ventures, L.P. ("Ventures"), which resulted in an increase in his indirect beneficial ownership of the shares of the issuer's common stock held by Ventures.
F3The noteholder has the right at any time prior to the payment in full of the note, to convert all or any portion of the unpaid principal balance of the note into shares of the issuer's common stock. This conversion right expires on March 1, 2019, the maturity date of the note, or upon the earlier payment in full of the unpaid principal balance of the note.