FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
UNIVERSAL HEALTH SERVICES INC [ UHS ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 01/11/2016 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Class B Common Stock | 01/11/2016 | J(1) | 39,958 | D | $0.00 | 60,042 | I | AMK 2014 LLC held by The Abby Miller King 2014 GRAT | ||
Class B Common Stock | 01/11/2016 | J(1) | 39,958 | A | $0.00 | 756,765 | D | |||
Class B Common Stock | 01/11/2016 | J(1) | 39,958 | D | $0.00 | 60,042 | I | MDM 2014 LLC held by The Marc Daniel Miller 2014 GRAT | ||
Class B Common Stock | 01/11/2016 | J(1) | 39,958 | A | $0.00 | 796,723 | D | |||
Class B Common Stock | 01/11/2016 | J(1) | 39,958 | D | $0.00 | 60,042 | I | MS 2014 LLC held by The Marni Spencer 2014 GRAT | ||
Class B Common Stock | 01/11/2016 | J(1) | 39,958 | A | $0.00 | 836,681 | D | |||
Class B Common Stock | 01/11/2016 | J(2) | 39,958 | D | $0.00 | 796,723 | D | |||
Class B Common Stock | 01/11/2016 | J(2) | 39,958 | A | $0.00 | 39,958 | I | AMK 2014 LLC held by The Abby Miller King 2015 GRAT | ||
Class B Common Stock | 01/11/2016 | J(2) | 39,958 | D | $0.00 | 756,765 | D | |||
Class B Common Stock | 01/11/2016 | J(2) | 39,958 | A | $0.00 | 39,958 | I | MDM 2014 LLC held by The Marc Daniel Miller 2015 GRAT | ||
Class B Common Stock | 01/11/2016 | J(2) | 39,958 | D | $0.00 | 716,807 | D | |||
Class B Common Stock | 01/11/2016 | J(2) | 39,958 | A | $0.00 | 39,958 | I | MS 2014 LLC held by The Marni Spencer 2015 GRAT |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Class A Common Stock | (3) | 01/11/2016 | J(1) | 39,958 | (4) | (5) | Class B Common Stock | 39,958 | $0.00 | 60,042 | I | AMK 2014 LLC held by The Abby Miller King 2014 GRAT | |||
Class A Common Stock | (3) | 01/11/2016 | J(1) | 39,958 | (4) | (5) | Class B Common Stock | 39,958 | $0.00 | 4,195,213 | D | ||||
Class A Common Stock | (3) | 01/11/2016 | J(1) | 59,937 | (4) | (5) | Class B Common Stock | 59,937 | $0.00 | 90,063 | I | MDM 2014 LLC held by The Marc Daniel Miller 2014 GRAT | |||
Class A Common Stock | (3) | 01/11/2016 | J(1) | 59,937 | (4) | (5) | Class B Common Stock | 59,937 | $0.00 | 4,255,150 | D | ||||
Class A Common Stock | (3) | 01/11/2016 | J(1) | 39,958 | (4) | (5) | Class B Common Stock | 39,958 | $0.00 | 60,042 | I | MS 2014 LLC held by The Marni Spencer 2014 GRAT | |||
Class A Common Stock | (3) | 01/11/2016 | J(1) | 39,958 | (4) | (5) | Class B Common Stock | 39,958 | $0.00 | 4,295,108 | D | ||||
Class A Common Stock | (3) | 01/11/2016 | J(2) | 59,937 | (4) | (5) | Class B Common Stock | 59,937 | $0.00 | 4,195,213 | D | ||||
Class A Common Stock | (3) | 01/11/2016 | J(2) | 59,937 | (4) | (5) | Class B Common Stock | 59,937 | $0.00 | 59,937 | I | MDM 2014 LLC held by The Marc Daniel Miller 2015 GRAT | |||
Class A Common Stock | (3) | 01/11/2016 | J(2) | 39,958 | (4) | (5) | Class B Common Stock | 39,958 | $0.00 | 4,155,255 | D | ||||
Class A Common Stock | (3) | 01/11/2016 | J(2) | 39,958 | (4) | (5) | Class B Common Stock | 39,958 | $0.00 | 39,958 | I | MS 2014 LLC held by The Marni Spencer2015 GRAT | |||
Class A Common Stock | (3) | 01/11/2016 | J(2) | 39,958 | (4) | (5) | Class B Common Stock | 39,958 | $0.00 | 39,958 | I | AMK 2014 LLC held by The Abby Miller King 2015 GRAT | |||
Class A Common Stock | (3) | 01/11/2016 | J(2) | 39,958 | (4) | (5) | Class B Common Stock | 39,958 | $0.00 | 4,255,150 | D |
Explanation of Responses: |
1. On 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. |
2. On 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. |
3. The Class A Common Stock is convertible into Class B Common Stock on a share for share basis. |
4. Immediately |
5. Not Applicable |
Remarks: |
/s/ Alan B. Miller | 01/13/2016 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |