Statement of Changes in Beneficial Ownership (4)
05 Mai 2022 - 4:32PM
Edgar (US Regulatory)
FORM 4
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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).
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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
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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
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MILLER ALAN B |
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 __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)
5/3/2022 |
(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 | 5/3/2022 | | J(1) | | 30713 | D | $0 | 24538 | I | Marc Daniel Miller 2021
GRAT |
Class B Common Stock | 5/3/2022 | | J(1) | | 30713 | A | $0 | 1092378 | D | |
Class B Common Stock | 5/4/2022 | | J(2) | | 30713 | D | $0 | 1061665 | D | |
Class B Common Stock | 5/4/2022 | | J(2) | | 30713 | A | $0 | 30713 | I | Marc Daniel Miller 2022 GRAT |
Class B Common Stock | 5/3/2022 | | J(3) | | 23035 | D | $0 | 18403 | I | Marni Spencer 2021
GRAT |
Class B Common Stock | 5/3/2022 | | J(3) | | 23035 | A | $0 | 1115413 | D | |
Class B Common Stock | 5/4/2022 | | J(4) | | 23035 | D | $0 | 1061665 | D | |
Class B Common Stock | 5/4/2022 | | J(4) | | 23035 | A | $0 | 23035 | I | Marni Spencer 2022 GRAT |
Class B Common Stock | 5/3/2022 | | J(5) | | 23035 | D | $0 | 18403 | I | Abby Miller King 2021
GRAT |
Class B Common Stock | 5/3/2022 | | J(5) | | 23035 | A | $0 | 1138448 | D | |
Class B Common Stock | 5/4/2022 | | J(6) | | 23035 | D | $0 | 1061665 | D | |
Class B Common Stock | 5/4/2022 | | J(6) | | 23035 | A | $0 | 23035 | I | Abby Miller King 2022 GRAT |
Class B Common Stock | | | | | | | | 83252 | I | AMK 2014 LLC as held
by Alan B. Miller |
Class B Common Stock | | | | | | | | 16748 | I | AMK 2014 LLC held by
The Abby Danielle Miller
2002 Trust |
Class B Common Stock | | | | | | | | 55763 | I | By The Abby Miller King
2011 Family Trust |
Class B Common Stock | | | | | | | | 175993 | I | MDM 2014 LLC as held
by Alan B. Miller |
Class B Common Stock | | | | | | | | 24007 | I | MDM 2014 LLC held by
The Marc Daniel Miller
2002 Trust |
Class B Common Stock | | | | | | | | 83252 | I | MS 2014 LLC as held by
Alan B. Miller |
Class B Common Stock | | | | | | | | 16748 | I | MS 2014 LLC held by
The Marni Spencer 2002
Trust |
Class B Common Stock | | | | | | | | 9810 | I | The Alan and Jill Miller
Foundation (7) |
Class B Common Stock | | | | | | | | 59900 | I | The Marc Daniel Miller
2011 Family Trust |
Class B Common Stock | | | | | | | | 55763 | I | The Marni Spencer 2011
Family Trust |
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) | 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 |
Explanation of Responses: |
(1) | On May 03, 2022 30,713 Class B shares were distributed to Alan B. Miller from the Marc Daniel Miller 2021 GRAT. Alan B. Miller's pecuniary interest in these shares is unchanged. All distributions hereinbefore described were made pursuant to the terms of the Trust Agreement creating each 2021 GRAT. |
(2) | On May 04, 2022 30,713 Class B shares were transferred from Alan B. Miller to the Marc Daniel Miller 2022 GRAT. |
(3) | On May 03, 2022 23,035 Class B shares were distributed to Alan B. Miller from the Marni Spencer 2021 GRAT. Alan B. Miller's pecuniary interest in these shares is unchanged. All distributions hereinbefore described were made pursuant to the terms of the Trust Agreement creating each 2021 GRAT. |
(4) | On May 04, 2022 23,035 Class B shares were transferred from Alan B. Miller to the Marni Spencer 2022 GRAT. |
(5) | On May 03, 2022 23,035 Class B shares were distributed to Alan B. Miller from the Abby Miller King 2021 GRAT. Alan B. Miller's pecuniary interest in these shares is unchanged. All distributions hereinbefore described were made pursuant to the terms of the Trust Agreement creating each 2021 GRAT. |
(6) | On May 04, 2022 23,035 Class B shares were transferred from Alan B. Miller to the Abby Miller King 2022 GRAT. |
(7) | 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. |
Reporting Owners
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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
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/s/ Steve Filton, Attorney-in-Fact for Alan B. Miller | | 5/5/2022 |
**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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