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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 | (1) | 07/02/2012 | J(2) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 769,994 | I | A. Miller Family, LLC | |||
Class A Common Stock | (1) | 07/02/2012 | J(2) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 129,400 | I | The Abby Danielle Miller 2002 Trust | |||
Class A Common Stock | (1) | 07/02/2012 | J(2) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 651,094 | I | A. Miller Family, LLC | |||
Class A Common Stock | (1) | 07/02/2012 | J(2) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 129,400 | I | The Marc Daniel Miller 2002 Trust | |||
Class A Common Stock | (1) | 07/02/2012 | J(2) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 532,194 | I | A. Miller Family, LLC | |||
Class A Common Stock | (1) | 07/02/2012 | J(2) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 129,400 | I | The Marni Spencer 2002 Trust | |||
Class A Common Stock | (1) | 07/03/2012 | J(3) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 10,500 | I | The Marni Spencer 2002 Trust | |||
Class A Common Stock | (1) | 07/03/2012 | J(3) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 118,900 | I | By The Marni Spencer Family 2012 Trust | |||
Class A Common Stock | (1) | 07/03/2012 | J(3) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 10,500 | I | The Marc Daniel Miller 2002 Trust | |||
Class A Common Stock | (1) | 07/03/2012 | J(3) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 118,900 | I | By The Marc Daniel Miller Family 2012 Trust | |||
Class A Common Stock | (1) | 07/03/2012 | J(3) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 10,500 | I | The Abby Danielle Miller 2002 Trust | |||
Class A Common Stock | (1) | 07/03/2012 | J(3) | 118,900 | (4) | (5) | Class B Common Stock | 118,900 | $ 0 | 118,900 | I | By The Abby Miller King Family 2012 Trust |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Miller Marc D UNIVERSAL HEALTH SERVICES, INC. 367 SOUTH GULPH ROAD KING OF PRUSSIA, PA 19406 |
X | President |
/s/ Marc D. Miller | 07/05/2012 | |
**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) | These shares are convertible to Class B Common Stock on a share for share basis. |
(2) | On July 2, 2012, 118,900 shares of Class A Common Stock (the "Shares") were distributed from A. Miller Family LLC to each of The Marc Daniel Miller 2002 Trust, The Marni Spencer 2002 Trust and The Abby Danielle Miller 2002 Trust. The Shares were then distributed to Mr. Marc Miller, Ms. Marni Spencer and Ms. Abby Miller King, respectively. |
(3) | On July 3, 2012, all of the Shares were transferred by Mr. Marc Miller, Ms. Marni Spencer and Ms. Abby Miller King to The Marc Daniel Miller Family 2012 Trust, The Marni Spencer Family 2012 Trust and The Abby Miller King Family 2012 Trust, respectively. |
(4) | Immediately. |
(5) | Not Applicable. |