0000899243-16-011252.txt : 20160107 0000899243-16-011252.hdr.sgml : 20160107 20160107125038 ACCESSION NUMBER: 0000899243-16-011252 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151231 FILED AS OF DATE: 20160107 DATE AS OF CHANGE: 20160107 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: Cook Charles E. CENTRAL INDEX KEY: 0001556960 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35639 FILM NUMBER: 161329655 MAIL ADDRESS: STREET 1: 8440 WALNUT HILL LANE STREET 2: SUITE 120 CITY: DALLAS STATE: TX ZIP: 75231 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-12-31 0 0001507881 USMD Holdings, Inc. USMD 0001556960 Cook Charles E. 8440 WALNUT HILL LANE SUITE 120 DALLAS TX 75231 1 0 0 0 Common Stock ($.01 par) 2015-12-31 4 A 0 2099 7.98 A 29506 D Common Stock ($.01 par) 140999 I Indirectly held through UANT Ventures, L.P. 7.25% Convertible Subordinated Note due 2020 10.61 2016-04-29 Common Stock ($.01 par) 23563 23563 D Represents stock compensation granted to reporting person under the 2010 USMD Holdings, Inc. Equity Compensation Plan for his services as a director for the period from October 2015 through December 2015. 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/ Charles E. Cook 2016-01-06