0001590503-17-000042.txt : 20170306 0001590503-17-000042.hdr.sgml : 20170306 20170306164143 ACCESSION NUMBER: 0001590503-17-000042 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170302 FILED AS OF DATE: 20170306 DATE AS OF CHANGE: 20170306 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Surgical Care Affiliates, Inc. CENTRAL INDEX KEY: 0001411574 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SPECIALTY OUTPATIENT FACILITIES, NEC [8093] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 510 LAKE COOK ROAD STREET 2: SUITE 400 CITY: DEERFIELD STATE: IL ZIP: 60015 BUSINESS PHONE: 847-236-0921 MAIL ADDRESS: STREET 1: 510 LAKE COOK ROAD STREET 2: SUITE 400 CITY: DEERFIELD STATE: IL ZIP: 60015 FORMER COMPANY: FORMER CONFORMED NAME: ASC Acquisition LLC DATE OF NAME CHANGE: 20070905 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Goulet Kenneth R CENTRAL INDEX KEY: 0001415516 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36154 FILM NUMBER: 17668415 MAIL ADDRESS: STREET 1: 120 MONUMENT CIRCLE CITY: INDIANAPOLIS STATE: IN ZIP: 46204 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2017-03-02 0001411574 Surgical Care Affiliates, Inc. SCAI 0001415516 Goulet Kenneth R C/O SURGICAL CARE AFFILIATES, INC. 510 LAKE COOK ROAD, SUITE 400 DEERFIELD IL 60015 1 0 0 0 Common Stock 2017-03-02 4 A 0 1059 0 A 3052 D Grant of restricted stock units of the issuer, vesting ratably in equal annual installments over a period of two years from March 2, 2017, pursuant to the Surgical Care Affiliates, Inc. 2016 Omnibus Long-Term Incentive Plan (the "Plan"), which is exempt under Rule 16b-3(d) of the Securities Exchange Act of 1934, as amended. Includes 3,052 shares of Common Stock underlying restricted stock units ("RSUs") of the issuer, all of which are subject to time-based vesting. The RSUs vest on the following schedule: 997 RSUs vesting on June 1, 2017, 530 RSUs vesting on March 1, 2018, 996 RSUs vesting on June 1, 2018 and 529 RSUs vesting on March 1, 2019. Each vested RSU is settled on the earlier of the individual's termination of employment (as defined in the Plan) or a change in control of the issuer. /s/ Richard L. Sharff, Jr., by power of attorney 2017-03-06