0001209191-15-026025.txt : 20150313
0001209191-15-026025.hdr.sgml : 20150313
20150313161540
ACCESSION NUMBER: 0001209191-15-026025
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140812
FILED AS OF DATE: 20150313
DATE AS OF CHANGE: 20150313
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: 15699533
MAIL ADDRESS:
STREET 1: 405 BAYOU VISTA
CITY: SOUTHLAKE
STATE: TX
ZIP: 76092
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2014-08-12
0
0001507881
USMD Holdings, Inc.
USMD
0001556868
Dickey Russell A.
405 BAYOU VISTA
SOUTHLAKE
TX
76092
1
0
0
0
Common Stock ($.01 par)
2014-08-12
4
A
0
2060
0.00
A
17237
D
Common Stock ($.01 par)
32174
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 the reporting person under the 2010 USMD Holdings, Inc. Equity Compensation Plan for his services as a director.
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
2015-03-13