SEC Form 4 · accession 0000899243-16-027927
USMD Holdings, Inc. · USMD
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
M. Patrick Collini
Director
Period of report
Dec 15, 2015
Accepted (ET)
Aug 23, 2016 · 5:00 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 | 1,987 | $7.65 | A | 22,844 | D | |
| Common Stock ($.01 par value) | holding | — | — | — | 130,929 | I | Indirectly held through UANT Ventures, L.P. | |
| Common Stock ($.01 par value) | holding | — | — | — | 13,248 | I | Indirectly held through M. Patrick Collini, MD, P.A. |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Option to purchaser | $24.84 | holding | — | — | — | Aug 31, 2012 | Aug 31, 2017 | Common Stock ($0.01 par) | 1,800 | 1,800 | I |
| 7.25% Convertible Subordinated Note due 2020F2 | $10.61 | holding | — | — | — | Apr 29, 2016 | — | Common Stock ($0.01 par) | 18,850 | 18,850 | D |
Explanation of responses
- F1Represents stock compensation issued pursuant to the 2010 USMD Holdings, Inc. Equity Compensation Plan and granted to Dr. Collini in lieu of compensation of $15,201 for his services as a physician employed by an affiliate of the issuer.
- F2The noteholder has the right at any time after April 29, 2016 but prior to the payment in full of the note by the issuer, 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 November 1, 2020, the maturity date of the note, or upon the earlier payment in full of the unpaid principal balance of the note.