SEC Form 4/A · accession 0000899243-16-028214
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
John M. House
Officer — Chief Executive Officer · Director
Period of report
Dec 31, 2015
Accepted (ET)
Aug 30, 2016 · 9:32 am 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 31, 2015 | A | 2,882 | $7.98 | A | 101,299 | D | |
| Common Stock ($.01 par value) | holding | — | — | — | 753,406 | 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. |
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) | 1,749 | 1,749 | I |
| 7.25% Convertible Subordinated Note due 2020F3,F2 | $10.61 | holding | — | — | — | Apr 29, 2016 | — | Common Stock ($0.01 par) | 23,563 | 23,563 | D |
Explanation of responses
- F1Represents stock compensation granted to reporting person under the 2010 USMD Holdings, Inc. Equity Compensation Plan for his services as a director for the period from October 2015 through December 2015. The number of shares held by the reporting person (Table I, Column 5) was erroneously reported in the original Form 4 as 100,299 shares, rather than the correct 101,299 shares.
- 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.
- F3The reporting person's holdings of the 7.25% Convertible Subordinated Note Due 2020 was erroneously left off the original Form 4 that was filed.