USMD Holdings, Inc. 4/A

4/A · USMD Holdings, Inc. · Filed Aug 30, 2016

Form 4/AAmended

Period: 2015-04-29

DirectorChief Executive Officer

Transactions

Purchase
7.25% Convertible Subordinated Note due 2020
2015-04-29$10.61/sh→ 23,563 total
Exercise: $10.61From: 2016-04-29→ Common Stock ($0.01 par) (23,563 underlying)

Holdings

Common Stock ($.01 par value)
(indirect: Indirectly held through John M. House MD, P.A)
13,248
Option to purchaser
(indirect: Indirectly held through UANT Ventures, L.P.)
Exercise: $24.84From: 2012-08-31Exp: 2017-08-31→ Common Stock ($0.01 par) (1,745 underlying)
1,745
Common Stock ($.01 par value)
(indirect: Indirectly held through UANT Ventures, L.P)
743,425
Common Stock ($.01 par value)
64,267

Footnotes (4)

[F1]The number of underlying and derivative securities held by the reporting person was erroneously reported in the original Form 4 as 1,813, rather than the correct 1,745.
[F2]In connection with a private offering conducted pursuant to Regulation D of the Securities Act of 1933, as amended, the issuer issued a 7.25% convertible subordinated note in the principal amount of $250,000 to the reporting person.
[F3]The noteholder has the right at any time after April 29, 2016 but prior to the payment in full of the note by the issuer, to convert all or any portion of the unpaid principal balance of the note into shares of the issuer's common stock. This conversion right expires on November 1, 2020, the maturity date of the note, or upon the earlier payment in full of the unpaid principal balance of the note
[F4]The number of derivative securities reported in Table II, Column 9 was erroneously reported as 26,563, rather than the correct 23,563.

Documents

1 file