Statement of Changes in Beneficial Ownership (4)
July 31 2019 - 4:38PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Miller Marc D
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2. Issuer Name
and
Ticker or Trading Symbol
UNIVERSAL HEALTH SERVICES INC
[
UHS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
President
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(Last)
(First)
(Middle)
UNIVERSAL HEALTH SERVICES, INC., 367 SOUTH GULPH ROAD
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3. Date of Earliest Transaction
(MM/DD/YYYY)
7/30/2019
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(Street)
KING OF PRUSSIA, PA 19406
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Class B Common Stock
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7/30/2019
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M
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45000
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A
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$152.47
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180237
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D
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Class B Common Stock
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7/30/2019
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F
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39028
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D
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$152.47
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141209
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D
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Class B Common Stock
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62275
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I
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AMK 2014 LLC as held by The Abby Miller King 2019 GRAT
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Class B Common Stock
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16748
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I
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AMK 2014 LLC held by The Abby Danielle Miller 2002 Trust
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Class B Common Stock
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20977
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I
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AMK 2014 LLC held by the Abby Miller King 2018 GRAT
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Class B Common Stock
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74660
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I
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MDM 2014 LLC as held by The Marc Daniel Miller 2018 GRAT
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Class B Common Stock
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101333
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I
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MDM 2014 LLC as held by The Marc Daniel Miller 2019 GRAT
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Class B Common Stock
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24007
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I
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MDM 2014 LLC held by The Marc Daniel Miller 2002 Trust
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Class B Common Stock
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20977
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I
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MS 2014 LLC as held by The Marni Spencer 2018 GRAT
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Class B Common Stock
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62275
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I
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MS 2014 LLC as held by The Marni Spencer 2019 GRAT
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Class B Common Stock
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16748
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I
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MS 2014 LLC held by The Marni Spencer 2002 Trust
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Class B Common Stock
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22815
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I
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The Abby Danielle Miller 2002 Trust
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Class B Common Stock
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55763
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I
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The Abby Miller King 2011 Family Trust
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Class B Common Stock
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44110
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I
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The Marc Daniel Miller 2002 Trust
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Class B Common Stock
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59900
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I
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The Marc Daniel Miller 2011 Family Trust
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Class B Common Stock
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43247
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I
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The Marni Spencer 2002 Trust
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Class B Common Stock
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55763
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I
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The Marni Spencer 2011 Family Trust
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Option To Purchase Class B Common Stock
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$117.29
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7/30/2019
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M
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45000
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(1)
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3/17/2020
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Class B Common Stock
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45000
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$0
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45000
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D
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Option To Purchase Class B Common Stock
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$118.62
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(2)
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3/22/2021
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Class B Common Stock
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100000
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100000
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D
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Option To Purchase Class B Common Stock
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$124.56
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(3)
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3/28/2022
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Class B Common Stock
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103000
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103000
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D
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Option To Purchase Class B Common Stock
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$119.64
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(4)
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4/12/2023
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Class B Common Stock
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100000
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100000
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D
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Option To Purchase Class B Common Stock
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$134.02
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(5)
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3/19/2024
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Class B Common Stock
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100000
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100000
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D
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Explanation of Responses:
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(1)
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Option vested ratably on each of 3/18/2016, 3/18/2017, 3/18/2018 and 3/18/2019.
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(2)
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Option vests ratably on each of 3/23/2017, 3/23/2018, 3/23/2019 and 3/23/2020.
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(3)
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Option vests ratably on each of 3/29/2018, 3/29/2019, 3/29/2020 and 3/29/2021.
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(4)
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Option vests ratably on each of 4/13/2019, 4/13/2020, 4/13/2021, and 4/13/2022.
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(5)
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Option vests ratably on each of 3/20/2020, 3/20/2021, 3/20/2022, and 3/20/2023.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Miller Marc D
UNIVERSAL HEALTH SERVICES, INC.
367 SOUTH GULPH ROAD
KING OF PRUSSIA, PA 19406
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X
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President
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Signatures
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/s/ Marc D. Miller
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7/31/2019
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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