SEC Form 4 · accession 0001209191-15-037714

USMD Holdings, Inc. · USMD

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

Reporting owner

Officer — Chief Executive Officer · Director

Period of report

Apr 29, 2015

Accepted (ET)

May 1, 2015 · 1:25 pm 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 ($.01 par)	holding	—	—	—	64,267	D
Common Stock ($.01 par)	holding	—	—	—	743,425	I	Indirectly held through UANT Ventures, L.P.
Common Stock ($.01 par)	holding	—	—	—	13,248	I	Held in 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^F1,F2	$10.61	Apr 29, 2015	P	—	A	Apr 29, 2016	—	Common Stock ($.01 par)	23,563	26,563	D
Options to Purchase	$24.84	holding	—	—	—	Aug 31, 2012	Aug 31, 2017	Common Stock ($.01 par)	1,813	1,813	I

F1In 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.
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 of the principal balance of the note.