SEC Form 4 · accession 0000899243-16-011677
UNIVERSAL HEALTH SERVICES INC · UHS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Alan B Miller
Officer — Chairman and CEO · Director · 10% Owner
Period of report
Jan 11, 2016
Accepted (ET)
Jan 13, 2016 · 9:17 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000352915
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | D | 60,042 | I | AMK 2014 LLC held by The Abby Miller King 2014 GRAT |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | A | 756,765 | D | |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | D | 60,042 | I | MDM 2014 LLC held by The Marc Daniel Miller 2014 GRAT |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | A | 796,723 | D | |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | D | 60,042 | I | MS 2014 LLC held by The Marni Spencer 2014 GRAT |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | A | 836,681 | D | |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | D | 796,723 | D | |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | A | 39,958 | I | AMK 2014 LLC held by The Abby Miller King 2015 GRAT |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | D | 756,765 | D | |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | A | 39,958 | I | MDM 2014 LLC held by The Marc Daniel Miller 2015 GRAT |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | D | 716,807 | D | |
| Class B Common Stock | Jan 11, 2016 | J | 39,958 | $0.00 | A | 39,958 | I | MS 2014 LLC held by The Marni Spencer 2015 GRAT |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 39,958 | D | — | — | Class B Common Stock | 39,958 | 60,042 | I |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 39,958 | A | — | — | Class B Common Stock | 39,958 | 4,195,213 | D |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 59,937 | D | — | — | Class B Common Stock | 59,937 | 90,063 | I |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 59,937 | A | — | — | Class B Common Stock | 59,937 | 4,255,150 | D |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 39,958 | D | — | — | Class B Common Stock | 39,958 | 60,042 | I |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 39,958 | A | — | — | Class B Common Stock | 39,958 | 4,295,108 | D |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 59,937 | D | — | — | Class B Common Stock | 59,937 | 4,195,213 | D |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 59,937 | A | — | — | Class B Common Stock | 59,937 | 59,937 | I |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 39,958 | D | — | — | Class B Common Stock | 39,958 | 4,155,255 | D |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 39,958 | A | — | — | Class B Common Stock | 39,958 | 39,958 | I |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 39,958 | A | — | — | Class B Common Stock | 39,958 | 39,958 | I |
| Class A Common StockF3,F4,F5 | — | Jan 11, 2016 | J | 39,958 | D | — | — | Class B Common Stock | 39,958 | 4,255,150 | D |
Explanation of responses
- F1On January 11, 2016, The Marc Daniel Miller 2014 GRAT distributed 39.95777% of its interest in MDM 2014 LLC to Alan B. Miller and each of The Abby Miller King 2014 GRAT and The Marni Spencer 2014 GRAT distributed 39.95804% of their respective interests in AMK 2014 LLC (as to The Abby Miller King 2014 GRAT) and MS 2014 LLC (as to The Marni Spencer 2014 GRAT) to Alan B. Miller (the distributions were made pursuant to the terms of the Trust Agreement creating each 2014 GRAT). The shares reflected represent the amount of shares held by each LLC as represented by the percentage LLC interests distributed. Mr. Miller's pecuniary interest in these shares is unchanged.
- F2On January 11, 2016, Alan B. Miller contributed 39.95777% of his interest in MDM 2014 LLC to The Marc Daniel Miller 2015 GRAT, 39.95804% of his interest in AMK 2014 LLC to The Abby Miller King 2015 GRAT and 39.95804% of his interest in MS 2014 LLC to The Marni Spencer 2015 GRAT. The shares reflected represent the amount of shares held by each LLC as represented by the percentage LLC interests contributed. Mr. Miller's pecuniary interest in these shares is unchanged.
- F3The Class A Common Stock is convertible into Class B Common Stock on a share for share basis.
- F4Immediately
- F5Not Applicable