SEC Form 4/A · accession 0000899243-16-028211

USMD Holdings, Inc. · USMD

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

This is an amendment (Form 4/A). It replaces an earlier filing for the same period.

Reporting owner

Officer — Chief Executive Officer · Director

Period of report

Apr 29, 2015

Accepted (ET)

Aug 30, 2016 · 9:29 am EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001507881

Table I — non-derivative securities

Security	Date	Code	Shares	A/D	Owned after	D/I	Nature of ownership
Common Stock ($.01 par value)	holding	—	—	—	64,267	D
Common Stock ($.01 par value)	holding	—	—	—	743,425	I	Indirectly held through UANT Ventures, L.P
Common Stock ($.01 par value)	holding	—	—	—	13,248	I	Indirectly held through John M. House MD, P.A

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
7.25% Convertible Subordinated Note due 2020^F2,F4,F3	$10.61	Apr 29, 2015	P	—	A	Apr 29, 2016	—	Common Stock ($0.01 par)	23,563	23,563	D
Option to purchaser^F1	$24.84	holding	—	—	—	Aug 31, 2012	Aug 31, 2017	Common Stock ($0.01 par)	1,745	1,745	I

F1The number of underlying and derivative securities held by the reporting person was erroneously reported in the original Form 4 as 1,813, rather than the correct 1,745.
F2In connection with a private offering conducted pursuant to Regulation D of the Securities Act of 1933, as amended, the issuer issued a 7.25% convertible subordinated note in the principal amount of $250,000 to the reporting person.
F3The 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
F4The number of derivative securities reported in Table II, Column 9 was erroneously reported as 26,563, rather than the correct 23,563.