Statement of Changes in Beneficial Ownership (4)
November 21 2022 - 04:45PM
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 ALAN B |
2. Issuer Name and Ticker or Trading
Symbol UNIVERSAL HEALTH SERVICES INC [ UHS ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director __X__
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Executive Chairman |
(Last)
(First)
(Middle)
UNIVERSAL HEALTH SERVICES, INC. |
3. Date of Earliest Transaction (MM/DD/YYYY)
11/21/2022
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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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Class B Common Stock |
11/21/2022 |
|
M |
|
200000 |
A |
$128.67 |
1261665 |
D |
|
Class B Common Stock |
11/21/2022 |
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F |
|
191927 |
D |
$128.67 |
1069738 |
D |
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Class B Common Stock |
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18403 |
I |
Abby Miller King 2021 GRAT |
Class B Common Stock |
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83252 |
I |
AMK 2014 LLC as held by Alan B.
Miller |
Class B Common Stock |
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16748 |
I |
AMK 2014 LLC held by The Abby Danielle Miller
2002 Trust |
Class B Common Stock |
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|
|
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55763 |
I |
By The Abby Miller King 2011 Family
Trust |
Class B Common Stock |
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|
|
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24538 |
I |
Marc Daniel Miller 2021
GRAT |
Class B Common Stock |
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18403 |
I |
Marni Spencer 2021 GRAT |
Class B Common Stock |
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175993 |
I |
MDM 2014 LLC as held by Alan B.
Miller |
Class B Common Stock |
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24007 |
I |
MDM 2014 LLC held by The Marc Daniel Miller 2002
Trust |
Class B Common Stock |
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83252 |
I |
MS 2014 LLC as held by Alan B.
Miller |
Class B Common Stock |
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16748 |
I |
MS 2014 LLC held by The Marni Spencer 2002
Trust |
Class B Common Stock |
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8623 |
I |
The Alan and Jill Miller
Foundation (1) |
Class B Common Stock |
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59900 |
I |
The Marc Daniel Miller 2011 Family
Trust |
Class B Common Stock |
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55763 |
I |
The Marni Spencer 2011 Family
Trust |
Class B Common Stock |
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23035 |
I |
Abby Miller King 2022 GRAT |
Class B Common Stock |
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30713 |
I |
Marc Daniel Miller 2022
GRAT |
Class B Common Stock |
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23035 |
I |
Marni Spencer 2022 GRAT |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. 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 |
7. Title and Amount of Securities Underlying
Derivative Security
(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) |
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Option To Purchase Class B Common
Stock |
$119.64 |
11/21/2022 |
|
M |
|
|
200000 |
(2) |
4/12/2023 |
Class B Common Stock |
200000 |
$0 |
390000 |
D |
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Explanation of
Responses: |
(1) |
Mr. Alan B. Miller disclaims
beneficial ownership of these securities, and this report shall not
be deemed an admission that Mr. Alan B. Miller is the beneficial
owner of these securities for purposes of Section 16 or for any
other purpose. |
(2) |
Option vested ratably on
each of 4/13/2019, 4/13/2020, 4/13/2021, and 4/13/2022. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
MILLER ALAN B
UNIVERSAL HEALTH SERVICES, INC.
KING OF PRUSSIA, PA 19406 |
X |
X |
Executive Chairman |
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Signatures
|
/s/ Alan B. Miller |
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11/21/2022 |
**Signature of Reporting
Person |
Date |
Reminder: Report on a separate line for each class
of securities beneficially owned directly or
indirectly. |
* |
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). |
Note: |
File three copies of this Form, one of
which must be manually signed. If space is insufficient, see
Instruction 6 for procedure. |
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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