SEC Form 4 · accession 0001209191-15-037731
USMD Holdings, Inc. · USMD
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Charles E. Cook
Director
Period of report
Apr 29, 2015
Accepted (ET)
May 1, 2015 · 1:45 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 ($.01 par) | holding | — | — | — | 21,014 | D | ||
| Common Stock ($.01 par) | holding | — | — | — | 131,206 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 7.25% Convertible Subordinated Note due 2020F1,F2 | $10.61 | Apr 29, 2015 | P | — | A | Apr 29, 2016 | — | Common Stock ($.01 par) | 23,563 | 23,563 | D |
Explanation of responses
- 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.