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) 03/29/2017 | ||||||||||||||||||||||||||
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 | 03/29/2017 | A(1) | 16,057 | A | $0 | 934,088 | D | |||
Class B Common Stock | 14,858 | I | AMK 2014 LLC held by The Abby Danielle Miller 2002 Trust | |||||||
Class B Common Stock | 22,259 | I | AMK 2014 LLC held by The Abby Miller King 2015 GRAT | |||||||
Class B Common Stock | 62,883 | I | AMK 2014 LLC held by The Abby Miller King 2017 GRAT | |||||||
Class B Common Stock | 55,763 | I | By The Abby Miller King 2011 Family Trust | |||||||
Class B Common Stock | 14,858 | I | MDM 2014 LLC held by The Marc Daniel Miller 2002 Trust | |||||||
Class B Common Stock | 22,259 | I | MDM 2014 LLC held by The Marc Daniel Miller 2015 GRAT | |||||||
Class B Common Stock | 62,883 | I | MDM 2014 LLC held by The Marc Daniel Miller 2017 GRAT | |||||||
Class B Common Stock | 14,858 | I | MS 2014 LLC held by The Marni Spencer 2002 Trust | |||||||
Class B Common Stock | 22,259 | I | MS 2014 LLC held by The Marni Spencer 2015 GRAT | |||||||
Class B Common Stock | 62,883 | I | MS 2014 LLC held by The Marni Spencer 2017 GRAT | |||||||
Class B Common Stock | 19,000 | I | The Alan and Jill Miller Foundation | |||||||
Class B Common Stock | 59,900 | I | The Marc Daniel Miller 2011 Family Trust | |||||||
Class B Common Stock | 55,763 | I | The Marni Spencer 2011 Family Trust |
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 | ||||||||
Option To Purchase Class B Common Stock | $124.56 | 03/29/2017 | A | 590,000 | (2) | 03/28/2022 | Class B Common Stock | 590,000 | $124.56 | 590,000 | D |
Explanation of Responses: |
1. These restricted shares were granted pursuant to the Universal Health Services, Inc. Amended and Restated 2010 Employees' Restricted Stock Purchase Plan and shall vest ratably on each of 3/29/2018, 3/29/2019, 3/29/2020 and 3/29/2021. |
2. Option vests ratably on each of 3/29/2018, 3/29/2019, 3/29/2020 and 3/29/2021. |
/s/ Steve Filton, Attorney-in-Fact for Alan B. Miller | 03/30/2017 | |
** 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. |