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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Class A Common Stock | (2) | 11/12/2014 | J(1) | 100,000 | (3) | (4) | Class B Common Stock | 100,000 | $ 0 | 4,023,550 | D | ||||
Class A Common Stock | (2) | 11/12/2014 | J(1) | 100,000 | (3) | (4) | Class B Common Stock | 100,000 | $ 0 | 100,000 | I | AMK 2014 LLC | |||
Class A Common Stock | (2) | 11/12/2014 | J(1) | 150,000 | (3) | (4) | Class B Common Stock | 150,000 | $ 0 | 4,023,550 | D | ||||
Class A Common Stock | (2) | 11/12/2014 | J(1) | 150,000 | (3) | (4) | Class B Common Stock | 150,000 | $ 0 | 150,000 | I | MDM 2014 LLC | |||
Class A Common Stock | (2) | 11/12/2014 | J(1) | 100,000 | (3) | (4) | Class B Common Stock | 100,000 | $ 0 | 4,023,550 | D | ||||
Class A Common Stock | (2) | 11/12/2014 | J(1) | 100,000 | (3) | (4) | Class B Common Stock | 100,000 | $ 0 | 100,000 | I | MS 2014 LLC |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MILLER ALAN B UNIVERSAL HEALTH SERVICES, INC. 367 SOUTH GULPH ROAD KING OF PRUSSIA, PA 19406 |
X | X | Chairman and CEO |
/s/ Alan B. Miller | 11/13/2014 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | On November 11, 2014, Mr. Alan B. Miller transferred 150,000 shares of Class A Common Stock to the MDM 2014 LLC and transferred 100,000 shares of Class A Common Stock to each of the AMK 2014 LLC and the MS 2014 LLC. On November 11, 2014, Mr. Alan B. Miller transferred 100,000 shares of Class B Common Stock to each of the AMK 2014 LLC, the MDM 2014 LLC and the MS 2014 LLC. These shares were previously directly held by Mr. Alan B. Miller and the transfer resulted in a change of beneficial ownership from direct to indirect. Mr. Alan B. Miller's pecuniary interest in these shares is unchanged. It is contemplated that following the transfers referred to above, the 100% ownership interest in the AMK 2014 LLC will be transferred to The Abby Miller King 2014 GRAT. The 100% ownership interest in the MDM 2014 LLC will be transferred to The Marc Daniel Miller 2014 GRAT. The 100% ownership interest in the MS 2014 LLC will be transferred to The Marni Spencer 2014 GRAT. Alan B. Miller's pecuniary interest in these shares will be unchanged. Marc D. Miller disclaims any pecuniary interest in these shares. |
(2) | The Class A Common Stock is convertible into Class B Common Stock on a share for share basis. |
(3) | Immediately |
(4) | Not Applicable |