0000899243-16-011261.txt : 20160107 0000899243-16-011261.hdr.sgml : 20160107 20160107125743 ACCESSION NUMBER: 0000899243-16-011261 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: Dickey Russell A. CENTRAL INDEX KEY: 0001556868 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35639 FILM NUMBER: 161329679 MAIL ADDRESS: STREET 1: 405 BAYOU VISTA CITY: SOUTHLAKE STATE: TX ZIP: 76092 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-12-31 0 0001507881 USMD Holdings, Inc. USMD 0001556868 Dickey Russell A. 405 BAYOU VISTA SOUTHLAKE TX 76092 1 0 0 0 Common Stock ($.01 par) 2015-12-31 4 A 0 1629 7.98 A 29233 D Common Stock ($.01 par) 33911 I Indirectly held through UANT Ventures, L.P. Right to purchase 23.37 2014-09-01 5% Convertible Subordinated Notes Due 2019 34498 34498 I Indiectly held through AOB Surgical Group, Ltd. 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 prior to the payment in full of the note, 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 March 1, 2019, the maturity date of the note, or upon the earlier payment in full of the principal balance of the note. /s/ Russell A. Dickey 2016-01-06