0000899243-15-001101.txt : 20150713
0000899243-15-001101.hdr.sgml : 20150713
20150713133952
ACCESSION NUMBER: 0000899243-15-001101
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150709
FILED AS OF DATE: 20150713
DATE AS OF CHANGE: 20150713
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: USMD Holdings, Inc.
CENTRAL INDEX KEY: 0001507881
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-GENERAL MEDICAL & SURGICAL HOSPITALS, NEC [8062]
IRS NUMBER: 272866866
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 6333 NORTH STATE HIGHWAY 161
STREET 2: SUITE 200
CITY: IRVING
STATE: TX
ZIP: 75038
BUSINESS PHONE: 214-493-4000
MAIL ADDRESS:
STREET 1: 6333 NORTH STATE HIGHWAY 161
STREET 2: SUITE 200
CITY: IRVING
STATE: TX
ZIP: 75038
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Collini M. Patrick
CENTRAL INDEX KEY: 0001556961
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35639
FILM NUMBER: 15985235
MAIL ADDRESS:
STREET 1: 1410 LONG AND WINDING ROAD
CITY: MANSFIELD
STATE: TX
ZIP: 76063
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-07-09
0
0001507881
USMD Holdings, Inc.
USMD
0001556961
Collini M. Patrick
1410 LONG AND WINDING ROAD
MANSFIELD
TX
76063
1
0
0
0
Common Stock ($.01 par)
2015-07-09
4
A
0
6343
8.40
A
13132
D
Common Stock ($.01 par)
120623
I
Indirectly held through UANT Ventures, L.P.
Common Stock ($.01 par)
13248
I
Held in M. Patrick Collini, MD, P.A
Options to Purchase
24.84
2012-08-31
2017-08-31
Common Stock ($.01 par)
1745
1745
I
Indiectly held through UANT Ventures, L.P.
7.25% Convertible Subordinated Notes due 2020
10.61
2016-04-29
Common Stock ($.01 par)
18850
18850
D
Represents stock compensation granted to the reporting person under the 2010 USMD Holdings, Inc. Equity Compensation Plan for his services as a physician employed by an affiliate of the issuer.
The noteholder has the right, at any time after April 29, 2016 but prior to the payment in full of the note by the issuer, to convert all or any portion of the unpaid principal balance of the note into shares of the issuer's common stock. This conversion right expires on November 1, 2020, the maturity date of the note, or upon the earlier payment in full of of the principal balance of the note.
/s/ M. Patrick Collini
2015-07-13