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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
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 Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Class A Common Stock | (1) | 01/19/2012 | J(2) | 64,324 | (3) | (4) | Class B Common Stock | 64,324 | $ 0 | 235,676 | I | By The Abby Miller King 2010 GRAT (B) | |||
Class A Common Stock | (1) | 01/19/2012 | J(2) | 85,766 | (3) | (4) | Class B Common Stock | 85,766 | $ 0 | 314,234 | I | By The Marc Daniel Miller 2010 GRAT (B) | |||
Class A Common Stock | (1) | 01/19/2012 | J(2) | 64,324 | (3) | (4) | Class B Common Stock | 64,324 | $ 0 | 235,676 | I | By The Marni Spencer 2010 GRAT (B) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Miller Marc D UNIVERSAL HEALTH SERVICES, INC. 367 SOUTH GULPH ROAD KING OF PRUSSIA, PA 19406 |
X | President |
/s/ Marc D. Miller | 01/20/2012 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The Class A Common Stock is convertible into Class B Common Stock on a share for share basis. |
(2) | On January 19, 2012, each of The Abby Miller King 2010 GRAT (B) and The Marni Spencer 2010 GRAT (B) distributed 64,324 shares of Class A Common Stock to Alan B. Miller. On January 19, 2012, The Marc Daniel Miller 2010 GRAT (B) distributed 85,766 shares of Class A Common Stock to Alan B. Miller. The transfer resulted in a change of beneficial ownership from indirect to direct. Mr. Alan B. Miller's pecuniary interest in these shares is unchanged. Marc D. Miller serves as Co-Trustee of each of these GRATs. |
(3) | Immediately |
(4) | Not Applicable |