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) 05/03/2021 | ||||||||||||||||||||||||||
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 | 05/03/2021 | J(1) | 45,621 | D | $0 | 0 | I | MDM 2014 LLC as held by The Marc Daniel Miller 2019 GRAT | ||
Class B Common Stock | 05/03/2021 | J(1) | 45,621 | A | $0 | 45,621 | I | MDM 2014 LLC as held by Alan B. Miller | ||
Class B Common Stock | 05/03/2021 | J(2) | 24,180 | D | $0 | 0 | I | MS 2014 LLC as held by The Marni Spencer 2019 GRAT | ||
Class B Common Stock | 05/03/2021 | J(2) | 24,180 | A | $0 | 24,180 | I | MS 2014 LLC as held by Alan B. Miller | ||
Class B Common Stock | 05/03/2021 | J(3) | 24,180 | D | $0 | 0 | I | AMK 2014 LLC as held by The Abby Miller King 2019 GRAT | ||
Class B Common Stock | 05/03/2021 | J(3) | 24,180 | A | $0 | 24,180 | I | AMK 2014 LLC as held by Alan B. Miller | ||
Class B Common Stock | 145,901 | D | ||||||||
Class B Common Stock | 16,748 | I | AMK 2014 LLC held by The Abby Danielle Miller 2002 Trust | |||||||
Class B Common Stock | 59,072 | I | AMK 2014 LLC held by the Abby Miller King 2020 GRAT | |||||||
Class B Common Stock | 130,372 | I | MDM 2014 LLC as held by The Marc Daniel Miller 2020 GRAT | |||||||
Class B Common Stock | 24,007 | I | MDM 2014 LLC held by The Marc Daniel Miller 2002 Trust | |||||||
Class B Common Stock | 59,072 | I | MS 2014 LLC as held by The Marni Spencer 2020 GRAT | |||||||
Class B Common Stock | 16,748 | I | MS 2014 LLC held by The Marni Spencer 2002 Trust | |||||||
Class B Common Stock | 22,815 | I | The Abby Danielle Miller 2002 Trust | |||||||
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 | ||||||||
Class A Common Stock | (4) | 05/03/2021 | J(1) | 34,216 | (5) | (6) | Class B Common Stock | 34,216 | $0 | 0 | I | MDM 2014 LLC as held by the Marc Daniel Miller 2019 GRAT | |||
Class A Common Stock | (4) | 05/03/2021 | J(1) | 34,216 | (5) | (6) | Class B Common Stock | 34,216 | $0 | 34,216 | I | MDM 2014 LLC as held by Alan B. Miller | |||
Class A Common Stock | (4) | 05/03/2021 | J(2) | 24,180 | (5) | (6) | Class B Common Stock | 24,180 | $0 | 0 | I | MS 2014 LLC as held by The Marni Spencer 2019 GRAT | |||
Class A Common Stock | (4) | 05/03/2021 | J(2) | 24,180 | (5) | (6) | Class B Common Stock | 24,180 | $0 | 24,180 | I | MS 2014 LLC as held by Alan B. Miller | |||
Class A Common Stock | (4) | 05/03/2021 | J(3) | 24,180 | (5) | (6) | Class B Common Stock | 24,180 | $0 | 0 | I | AMK 2014 LLC as held by the Abby Miller King 2019 GRAT | |||
Class A Common Stock | (4) | 05/03/2021 | J(3) | 24,180 | (5) | (6) | Class B Common Stock | 24,180 | $0 | 24,180 | I | AMK 2014 LLC as held by Alan B. Miller | |||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 532,194 | 532,194 | I | A. Miller Family, LLC | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 61,500 | 61,500 | I | Abby Danielle Miller Subtrust u/ Miller Family 2017 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 16,748 | 16,748 | I | AMK 2014 LLC held by The Abby Danielle Miller 2002 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 59,072 | 59,072 | I | AMK 2014 LLC held by the Abby Miller King 2020 GRAT | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 118,900 | 118,900 | I | By The Abby Miller King Family 2012 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 118,900 | 118,900 | I | By The Marc Daniel Miller Family 2012 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 118,900 | 118,900 | I | By The Marni Spencer Family 2012 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 61,500 | 61,500 | I | Marc Daniel Miller Subtrust u/ Miller Family 2017 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 61,500 | 61,500 | I | Marni Spencer Subtrust u/ Miller Family 2017 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 97,779 | 97,779 | I | MDM 2014 LLC as held by The Marc Daniel Miller 2020 GRAT | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 18,005 | 18,005 | I | MDM 2014 LLC held by The Marc Daniel Miller 2002 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 59,072 | 59,072 | I | MS 2014 LLC as held by The Marni Spencer 2020 GRAT | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 16,748 | 16,748 | I | MS 2014 LLC held by The Marni Spencer 2002 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 99,063 | 99,063 | I | The Abby Danielle Miller 2002 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 139,195 | 139,195 | I | The Marc Daniel Miller 2002 Trust | |||||||
Class A Common Stock | (4) | (5) | (6) | Class B Common Stock | 99,063 | 99,063 | I | The Marni Spencer 2002 Trust |
Explanation of Responses: |
1. On May 03, 2021, The Marc Daniel Miller 2019 GRAT distributed 22.81049% of the MDM 2014 LLC to Alan B. Miller. Marc Miller disclaims any pecuniary interest in these shares. All distributions hereinbefore described were made pursuant to the terms of the Trust Agreement creating each 2019 GRAT. The MDM 2014 LLC holds 200,000 shares of Class B Common Stock and 150,000 shares of Class A Common Stock. |
2. On May 03, 2021, The Marni Spencer 2019 GRAT distributed 24.18044% of the MS 2014 LLC to Alan B. Miller. Marc Miller disclaims any pecuniary interest in these shares. All distributions hereinbefore described were made pursuant to the terms of the Trust Agreement creating each 2019 GRAT. The MS 2014 LLC holds 100,000 shares of Class B Common Stock and 100,000 shares of Class A Common Stock. |
3. On May 03, 2021, The Abby Miller King 2019 GRAT distributed 24.18044% of the AMK 2014 LLC to Alan B. Miller. Marc Miller disclaims any pecuniary interest in these shares. All distributions hereinbefore described were made pursuant to the terms of the Trust Agreement creating each 2019 GRAT. The AMK 2014 LLC holds 100,000 shares of Class B Common Stock and 100,000 shares of Class A Common Stock. |
4. The Class A Common Stock is convertible into Class B Common Stock on a share for share basis. |
5. Immediately. |
6. Not Applicable. |
/s/ Steve Filton, Attorney in Fact for Marc D. Miller | 05/05/2021 | |
** 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. |