SEC Form 4 · accession 0000899243-17-005029

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

Feb 17, 2017

Accepted (ET)

Feb 22, 2017 · 9:46 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	Feb 17, 2017	J	60,042	$0.00	D	0	I	AMK 2014 LLC held by The Abby Miller King 2014 GRAT
Class B Common Stock	Feb 17, 2017	J	45,184	$0.00	A	967,061	D
Class B Common Stock	Feb 17, 2017	J	14,858	$0.00	A	14,858	I	AMK 2014 LLC held by The Abby Danielle Miller 2002 Trust
Class B Common Stock	Feb 17, 2017	J	60,042	$0.00	D	0	I	MDM 2014 LLC held by The Marc Daniel Miller 2014 GRAT
Class B Common Stock	Feb 17, 2017	J	45,184	$0.00	A	1,012,245	D
Class B Common Stock	Feb 17, 2017	J	14,858	$0.00	A	14,858	I	MDM 2014 LLC held by The Marc Daniel Miller 2002 Trust
Class B Common Stock	Feb 17, 2017	J	60,042	$0.00	D	0	I	MS 2014 LLC held by The Marni Spencer 2014 GRAT
Class B Common Stock	Feb 17, 2017	J	45,184	$0.00	A	1,057,429	D
Class B Common Stock	Feb 17, 2017	J	14,858	$0.00	A	14,858	I	MS 2014 LLC held by The Marni Spencer 2002 Trust
Class B Common Stock	Feb 17, 2017	J	17,699	$0.00	D	22,259	I	AMK 2014 LLC held by The Abby Miller King 2015 GRAT
Class B Common Stock	Feb 17, 2017	J	17,699	$0.00	A	1,075,128	D
Class B Common Stock	Feb 17, 2017	J	17,699	$0.00	D	22,259	I	MDM 2014 LLC held by The Marc Daniel Miller 2015 GRAT
Class B Common Stock	Feb 17, 2017	J	17,699	$0.00	A	1,092,827	D
Class B Common Stock	Feb 17, 2017	J	17,699	$0.00	D	22,259	I	MS 2014 LLC held by The Marni Spencer 2015 GRAT
Class B Common Stock	Feb 17, 2017	J	17,699	$0.00	A	1,110,526	D
Class B Common Stock	Feb 17, 2017	J	62,883	$0.00	D	1,047,643	D
Class B Common Stock	Feb 17, 2017	J	62,883	$0.00	A	62,883	I	AMK 2014 LLC held by The Abby Miller King 2017 GRAT
Class B Common Stock	Feb 17, 2017	J	62,883	$0.00	D	984,760	D
Class B Common Stock	Feb 17, 2017	J	62,883	$0.00	A	62,883	I	MDM 2014 LLC held by The Marc Daniel Miller 2017 GRAT
Class B Common Stock	Feb 17, 2017	J	62,883	$0.00	D	921,877	D
Class B Common Stock	Feb 17, 2017	J	62,883	$0.00	A	62,883	I	MS 2014 LLC held by The Marni Spencer 2017 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 Stock^F4,F6,F7	—	Feb 17, 2017	J	60,042	D	—	—	Class B Common Stock	60,042	0	I
Class A Common Stock^F4,F6,F7	—	Feb 17, 2017	J	45,184	A	—	—	Class B Common Stock	45,184	4,200,439	D
Class A Common Stock^F1,F2,F6,F7	—	Feb 17, 2017	J	14,858	A	—	—	Class B Common Stock	14,858	14,858	I
Class A Common Stock^F4,F6,F7	—	Feb 17, 2017	J	90,063	D	—	—	Class B Common Stock	90,063	0	I
Class A Common Stock^F4,F6,F7	—	Feb 17, 2017	J	67,776	A	—	—	Class B Common Stock	67,776	4,268,215	D
Class A Common Stock^F1,F2,F6,F7	—	Feb 17, 2017	J	22,287	A	—	—	Class B Common Stock	22,287	22,287	I
Class A Common Stock^F4,F6,F7	—	Feb 17, 2017	J	60,042	D	—	—	Class B Common Stock	60,042	0	I
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	45,184	A	—	—	Class B Common Stock	45,184	4,313,399	D
Class A Common Stock^F1,F2,F6,F7	—	Feb 17, 2017	J	14,858	A	—	—	Class B Common Stock	14,858	14,858	I
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	17,699	D	—	—	Class B Common Stock	17,699	22,259	I
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	17,699	A	—	—	Class B Common Stock	17,699	4,331,098	D
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	26,549	D	—	—	Class B Common Stock	26,549	33,388	I
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	26,549	A	—	—	Class B Common Stock	26,549	4,357,647	D
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	17,699	D	—	—	Class B Common Stock	17,699	22,259	I
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	17,699	A	—	—	Class B Common Stock	17,699	4,375,346	D
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	62,883	D	—	—	Class B Common Stock	62,883	4,312,463	D
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	62,883	A	—	—	Class B Common Stock	62,883	62,883	I
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	94,325	D	—	—	Class B Common Stock	94,325	4,218,138	D
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	94,325	A	—	—	Class B Common Stock	94,325	94,325	I
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	62,883	D	—	—	Class B Common Stock	62,883	4,155,255	D
Class A Common Stock^F5,F6,F7	—	Feb 17, 2017	J	62,883	A	—	—	Class B Common Stock	62,883	62,883	I
Class A Common Stock^F5,F6,F7	—	holding	—	—	—	—	—	Class B Common Stock	400,000	400,000	I
Class A Common Stock^F5,F6,F7	—	holding	—	—	—	—	—	Class B Common Stock	258,630	258,630	I

Explanation of responses

F1On February 17, 2017, The Marc Daniel Miller 2014 GRAT distributed a 45.18379% interest in MDM 2014 LLC to Alan B. Miller, The Abby Miller King 2014 GRAT distributed a 45.18437% interest in AMK 2014 LLC to Alan B. Miller and The Marni Spencer 2014 GRAT distributed a 45.18437% interest of MS 2014 LLC to Alan B. Miller 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. In addition, The Marc Daniel Miller 2014 GRAT distributed a 14.85844% interest in MDM 2014 LLC to The Marc Daniel Miller 2002 Trust, The Abby Miller King 2014 GRAT distributed a 14.85759% interest in AMK 2014 LLC to The Abby Danielle Miller 2002 Trust and The Marni Spencer 2014 GRAT distributed a 14.85759% interest in MS 2014 LLC to The Marni Spencer 2002 Trust.
F2(Continued From footnote 1) All distributions hereinbefore described were made pursuant to the terms of the Trust Agreement creating each 2014 GRAT. Each 2014 GRAT has now terminated.
F3On February 17, 2017, The Marc Daniel Miller 2015 GRAT distributed a 17.69925% interest in MDM 2014 LLC to Alan B. Miller, The Abby Miller King 2015 GRAT distributed a 17.69948% interest in AMK 2014 LLC to Alan B. Miller and The Marni Spencer 2015 GRAT distributed a 17.69948% interest in MS 2014 LLC to Alan B. Miller (the distributions were made pursuant to the terms of the Trust Agreement creating each 2015 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.
F4On February 17, 2017, Alan B. Miller contributed a 62.88303% interest in MDM 2014 LLC to The Marc Daniel Miller 2017 GRAT, a 62.88385% interest in AMK 2014 LLC to The Abby Miller King 2017 GRAT and a 62.88385% interest in MS 2014 LLC to The Marni Spencer 2017 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.
F5The Class A Common Stock is convertible into Class B Common Stock on a share for share basis.
F6Immediately
F7Not Applicable