0000899243-16-025622.txt : 20160725 0000899243-16-025622.hdr.sgml : 20160725 20160725120436 ACCESSION NUMBER: 0000899243-16-025622 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160722 FILED AS OF DATE: 20160725 DATE AS OF CHANGE: 20160725 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: 161781580 MAIL ADDRESS: STREET 1: 405 BAYOU VISTA CITY: SOUTHLAKE STATE: TX ZIP: 76092 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-07-22 0 0001507881 USMD Holdings, Inc. USMD 0001556868 Dickey Russell A. 405 BAYOU VISTA SOUTHLAKE TX 76092 1 0 0 0 Common Stock ($.01 par value) 29223 D Common Stock ($.01 par value) 2016-07-22 4 J 0 95 3.90 A 39541 I Indirectly held through UANT Ventures, L.P. Common Stock ($.01 par value) 2016-07-22 4 J 0 26 2.17 D 39515 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 Indirectly held through AOB Surgical Group, Ltd. Dr. Dickey purchased additional partnership interests in UANT Ventures, L.P. ("Ventures"), which resulted in an increase in his indirect beneficial ownership of the shares of the issuer's common stock held by Ventures. As reported in a Form 4 filed on May 6, 2016, Dr. Dickey acquired additional partnership interests in Ventures, which increased his indirect beneficial ownership of the shares of the issuer's common stock held by Ventures. There was an error in the calculation of the amount of partnership interests Dr. Dickey was entitled to acquire in that transaction, which resulted in Dr. Dickey's acquisition of more partnership interests in Ventures than was intended. To correct the miscalculation, on July 22, 2016, Dr. Dickey disposed of some of his partnership interests in Ventures, which decreased his indirect beneficial ownership of the issuer. 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 unpaid principal balance of the note. /s/ Russell A. Dickey 2016-07-25