SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol UNIVERSAL HEALTH SERVICES INC [ UHS ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 08/23/2018 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction 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 | 08/23/2018 | J(1) | 20,432 | D | $0 | 22,815 | I | The Abby Danielle Miller 2002 Trust | ||
Class B Common Stock | 112,615 | D | ||||||||
Class B Common Stock | 16,748 | I | AMK 2014 LLC held by The Abby Danielle Miller 2002 Trust | |||||||
Class B Common Stock | 31,319 | I | AMK 2014 LLC held by The Abby Miller King 2017 GRAT | |||||||
Class B Common Stock | 51,933 | I | AMK 2014 LLC held by the Abby Miller King 2018 GRAT | |||||||
Class B Common Stock | 131,097 | I | MDM 2014 LLC as held by The Marc Daniel Miller 2018 GRAT | |||||||
Class B Common Stock | 24,007 | I | MDM 2014 LLC held by The Marc Daniel Miller 2002 Trust | |||||||
Class B Common Stock | 44,896 | I | MDM 2014 LLC held by The Marc Daniel Miller 2017 GRAT | |||||||
Class B Common Stock | 51,933 | I | MS 2014 LLC as held by The Marni Spencer 2018 GRAT | |||||||
Class B Common Stock | 16,748 | I | MS 2014 LLC held by The Marni Spencer 2002 Trust | |||||||
Class B Common Stock | 31,319 | I | MS 2014 LLC held by The Marni Spencer 2017 GRAT | |||||||
Class B Common Stock | 55,763 | I | The Abby Miller King 2011 Family Trust | |||||||
Class B Common Stock | 44,110 | I | The Marc Daniel Miller 2002 Trust | |||||||
Class B Common Stock | 59,900 | I | The Marc Daniel Miller 2011 Family Trust | |||||||
Class B Common Stock | 43,247 | I | The Marni Spencer 2002 Trust | |||||||
Class B Common Stock | 55,763 | I | The Marni Spencer 2011 Family Trust |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 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: 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 |
Explanation of Responses: |
1. On August 23, 2018 the Abby Danielle Miller 2002 Trust distributed 20,432 Class B shares to the Trust's beneficiary, Abby Miller King. Marc D. Miller disclaims beneficial ownership of shares in the Abby Danielle Miller 2002 Trust and any shares held by Abby Miller King. |
/s/ Steve Filton, Attorney in Fact for Marc D. Miller | 08/24/2018 | |
** 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 Number. |