0000899243-16-027923.txt : 20160823 0000899243-16-027923.hdr.sgml : 20160823 20160823165821 ACCESSION NUMBER: 0000899243-16-027923 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151215 FILED AS OF DATE: 20160823 DATE AS OF CHANGE: 20160823 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: Brock Steven CENTRAL INDEX KEY: 0001556888 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35639 FILM NUMBER: 161847699 MAIL ADDRESS: STREET 1: 1211 GREENBRIAR LANE CITY: ARLINGTON STATE: TX ZIP: 76013 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2015-12-15 0 0001507881 USMD Holdings, Inc. USMD 0001556888 Brock Steven 1211 GREENBRIAR LANE ARLINGTON TX 76013 1 0 0 0 Common Stock ($.01 par value) 2015-12-15 4 A 0 1611 7.65 A 19114 D Common Stock ($.01 par value) 2016-08-19 4 J 0 316 4.69 A 39198 I Indirectly held through UANT Ventures, L.P. Right to purchaser 23.37 2014-09-01 5% Convertible Subordinated Notes Due 2019 5750 5750 I Indirectly held through AOB Surgical Group, Ltd. Represents stock compensation issued pursuant to the 2010 USMD Holdings, Inc. Equity Compensation Plan and granted to Dr. Brock in lieu of compensation of $12,324 for his services as a physician employed by an affiliate of the issuer. Dr. Brock 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. 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/ Steven Brock 2016-08-23