SEC FORM
4
SEC Form 4
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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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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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 ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
Executive Vice President, UHS |
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3. Date of Earliest Transaction
(Month/Day/Year) 03/18/2020
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4. 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 Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Class B Common Stock |
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23.2353
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D |
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Option To Purchase Class B Common Stock |
$67.69
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03/18/2020 |
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A
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25,000 |
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03/17/2025 |
Class B Common Stock |
25,000 |
$67.69
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25,000 |
D |
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Option To Purchase Class B Common Stock |
$74.46
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03/18/2020 |
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A
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29,610 |
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03/17/2025 |
Class B Common Stock |
29,610 |
$74.46
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29,610 |
D |
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Explanation of Responses: |
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/s/ Steve Filton, Attorney-in-Fact for Mr. Peterson |
03/20/2020 |
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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
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. |
POWER OF ATTORNEY
I, Matthew J. Peterson, do hereby designate
Steve Filton to act as my lawful attorney-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 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/ Matthew J. Peterson
Signed and dated on this 3rd day of October, 2019.
The undersigned, Steve Filton hereby affirms that he
is the person named herein as attorney-in-fact and
that his original signature is affixed hereto.
/s/ Steve Filton
Signed and dated on this 3rd day of October, 2019.
COMMONWEALTH OF PENNSYLVANIA COUNTY OF MONTGOMERY
On this 3rd day of October, in the year 2019, before me,
Douglas R. Tewksbury, personally appeared
Matthew J. Peterson and Steve Filton, personally known
to me and have executed this document in my presence.
/s/ Douglas R. Tewksbury
(SEAL) 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