0000927066-21-000156.txt : 20210908 0000927066-21-000156.hdr.sgml : 20210908 20210908175955 ACCESSION NUMBER: 0000927066-21-000156 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210903 FILED AS OF DATE: 20210908 DATE AS OF CHANGE: 20210908 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: STAFFIERI MICHAEL DAVID CENTRAL INDEX KEY: 0001604063 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14106 FILM NUMBER: 211243084 MAIL ADDRESS: STREET 1: 2000 16TH STREET CITY: DENVER STATE: CO ZIP: 80202 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DAVITA INC. CENTRAL INDEX KEY: 0000927066 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 510354549 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2000 16TH STREET CITY: DENVER STATE: CO ZIP: 80202 BUSINESS PHONE: 310-536-2668 MAIL ADDRESS: STREET 1: 2000 16TH STREET CITY: DENVER STATE: CO ZIP: 80202 FORMER COMPANY: FORMER CONFORMED NAME: DAVITA HEALTHCARE PARTNERS INC. DATE OF NAME CHANGE: 20121107 FORMER COMPANY: FORMER CONFORMED NAME: DAVITA INC DATE OF NAME CHANGE: 20001005 FORMER COMPANY: FORMER CONFORMED NAME: TOTAL RENAL CARE HOLDINGS INC DATE OF NAME CHANGE: 19950524 4 1 wf-form4_163113837369033.xml FORM 4 X0306 4 2021-09-03 0 0000927066 DAVITA INC. DVA 0001604063 STAFFIERI MICHAEL DAVID C/O DAVITA INC. 2000 16TH STREET DENVER CO 80202 0 1 0 0 Chief Operating Officer, DKC Common Stock 2021-09-03 4 M 0 37101 65.48 A 117783 D Common Stock 2021-09-03 4 D 0 18195 133.52 D 99588 D Common Stock 2021-09-03 4 F 0 10192 133.52 D 89396 D Common Stock 42431 I by 2012 Staffieri Family Trust Stock Appreciation Rights 65.48 2021-09-03 4 M 0 37101 0 D 2020-05-15 2022-06-06 Common Stock 37101.0 0 D Represents the shares withheld in payment of the base price in connection with the exercise of Stock Appreciation Rights reported on this Form 4. Represents the shares withheld to satisfy the tax withholding obligation in connection with the exercise of Stock Appreciation Rights reported on this Form 4. The Stock Appreciation Rights were granted on June 6, 2017, which vested 50% each on May 15, 2020 and May 15, 2021. /s/ Stephanie N. Berberich, Attorney-in-Fact 2021-09-08