SEC FORM
3
SEC Form 3
| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
03/01/2020
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3. Issuer Name and Ticker or Trading Symbol
UNIVERSAL HEALTH SERVICES INC
[ UHS ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
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| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
| No securities are beneficially owned. |
|
/s/ Charles F. Boyle, Attorney-in-Fact for Ms. Singer |
03/09/2020 |
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** 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
5
(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. |
POWER OF ATTORNEY
I, Maria R. Singer, do hereby designate Alan B. Miller, Steve Filton,
and Charles F. Boyle to act as my lawful attorneys-in-fact to execute
and have delivered on my behalf, with the Securities and Exchange
Commission and the New York Stock Exchange, certain forms as they
pertain to my reporting of holdings of Universal Health
Services, Inc., Common Stock. Such necessary forms shall consist
of a Form 3, Initial Statement of Beneficial Ownership,
Form 4, Statement of Changes in Beneficial Ownership and
Form 5, Annual Statement of Changes in Beneficial Ownership.
I hereby ratify and confirm all that said attorney shall lawfully
do or cause to be done by virtue hereof.
/s/ Maria R. Singer
Signed and dated on this 6th day of March, 2020.
On this 6th day of March, in the year 2020, before me,
Patricia Orlando, personally appeared Maria R. Singer,
personally known to me and have executed this document
in-my presence.
PATRICA A ORLANDO I
/s/ Patricia A. Orlando
Signature of Notary Public
(SEAL)
NOTARY PUBUC STATE OF NEW YORK' QUEENS COUNTY
The undersigned, Alan B. Miller, Steve Filton,
and Charles F. Boyle hereby affirm that we are the
persons named herein as attorneys-in-fact and that
our original signatures are affixed hereto.
/s/ Alan B. Miller
/s/ Steve Filton
/s/ Charles F. Boyle
Signed and dated on this 6th day of March, 2020.
COMMONWEALTH OF PENNSYLVANIA COUNTY OF MONTGOMERY
On this 6th day of March, in the year 2020, before me,
Douglas R. Tewksbury, personally appeared Alan B. Miller,
Steve Filton, and Charles F. Boyle, personally known
to me and have executed this document in my presence.
/s/ Douglas R. Tewksbury
Signature of Notary Public
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
DOUGLAS R. TEWKSBURY, Notary Public
Upper Merion Twp., Montgomery County
My Commission Expires October 25, 2020
