SEC Form 4 · accession 0000899243-16-027923
USMD Holdings, Inc. · USMD
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Steven Brock
Director
Period of report
Dec 15, 2015
Accepted (ET)
Aug 23, 2016 · 4:58 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 | 1,611 | $7.65 | A | 19,114 | D | |
| Common Stock ($.01 par value)F2 | Aug 19, 2016 | J | 316 | $4.69 | A | 39,198 | I | Indirectly held through UANT Ventures, L.P. |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Right to purchaserF3 | $23.37 | holding | — | — | — | Sep 1, 2014 | — | 5% Convertible Subordinated Notes Due 2019 | 5,750 | 5,750 | I |
Explanation of responses
- F1Represents stock compensation issued pursuant to the 2010 USMD Holdings, Inc. Equity Compensation Plan and granted to Dr. Brock in lieu of compensation of $12,324 for his services as a physician employed by an affiliate of the issuer.
- F2Dr. Brock 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.