SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL 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).
  
Form 3 Holdings Reported.
  
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
FRIST PATRICIA C

(Last) (First) (Middle)
3100 WEST END AVENUE

(Street)
NASHVILLE TN 37203

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
HCA Holdings, Inc. [ HCA ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2013
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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 at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock, par value $0.01 per share 02/25/2013 G 485,292 D $0.00 0 I Held indirectly through Hercules Holding II, LLC by Patricia C. Frist 2010 GRAT No. 2(1)(2)
Common Stock, par value $0.01 per 02/25/2013 G 485,295 D $0.00 0 I Held indirectly through Hercules Holding II, LLC by Thomas F. Frist 2010 GRAT No. 4(1)(3)
Common Stock, par value $0.01 per 11/25/2013 G 517,674 D $0.00 0 I Held indirectly through Hercules Holding II, LLC by Thomas F. Frist, Jr. 2011 GRAT No. 1(1)(3)
Common Stock, par value $0.01 per 11/25/2013 G 232,836 D $0.00 0 I Held indirectly through Hercules Holding II, LLC by Patricia Champion Frist 2011 GRAT No. 1(1)(2)
Common Stock, par value $0.01 per 204,968.4898 I Held indirectly through Hercules Holding II, LLC(1)(4)
Common Stock, par value $0.01 per 60,934.6299 I Held indirectly through Hercules Holding II, LLC by Dr. Thomas F. Frist, Jr.(1)(4)
Common Stock, par value $0.01 per 387,659.7546 I Held indirectly through Hercules Holding II, LLC by Frist Children's Trust(1)(3)
Common Stock, par value $0.01 per 6,657,331.3176 I Held indirectly through Hercules Holding II, LLC by Frist Children's Trust II(1)(3)
Common Stock, par value $0.01 per 2,902,355.8722 I Held indirectly through Hercules Holding II, LLC by Thomas F. Frist, Jr. 2012 GRAT No. 1(1)(3)
Common Stock, par value $0.01 per 835,726.7964 I Held indirectly through Hercules Holding II, LLC by Thomas F. Frist, Jr. 2012 GRAT No. 2(1)(3)
Common Stock, par value $0.01 per 630,884.3884 I Held indirectly through Hercules Holding II, LLC by Thomas F. Frist, Jr. 2013 GRAT(1)(3)
Common Stock, par value $0.01 per 72,589.0649 I Held indirectly through Hercules Holding II, LLC by Thomas F. Frist GST Tax Exempt Trust(1)(2)
Common Stock, par value $0.01 per 6,465,982 I Held indirectly through Hercules Holding II, LLC by Thomas F. Frist, Jr. 2009 GRAT(1)(2)
Common Stock, par value $0.01 per 382,700.8834 I Held indirectly through Hercules Holding II, LLC by Patricia Champion Frist 2013 GRAT(1)(2)
Common Stock, par value $0.01 per 340,217 I Held indirectly through Hercules Holding II, LLC by Patricia Champion Frist 2013 GRAT No. 3(1)(2)
Common Stock, par value $0.01 per 36,629,163.8593 I Held indirectly through Hercules Holding II, LLC by Frisco, Inc.(1)(5)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. Hercules Holding II, LLC ("Hercules") holds 128,918,383 shares of the common stock of HCA Holdings, Inc. Hercules has issued one unit per share of HCA Holdings, Inc. that it owns directly. Hercules is held by a private investor group, including affiliates of Bain Capital Investors, LLC, Kohlberg Kravis Roberts & Co. L.P. and affiliates of HCA Inc. founder Dr. Thomas F. Frist, Jr. The Reporting Person may be deemed to be a member of a group exercising voting and investment control over the shares of common stock of HCA Holdings, Inc. held by Hercules. However, the Reporting Person disclaims membership in any such group and disclaims beneficial ownership of these securities, except to the extent of her pecuniary interest therein.
2. The Reporting Person may be deemed to be the beneficial of the units of Hercules held by (i) Thomas F. Frist GST Tax Exempt Trust, (ii) Thomas F. Frist, Jr. 2009 Grantor Retained Annuity Trust, (iii) Patricia Champion Frist 2013 Grantor Retained Annuity Trust, (iv) Patricia Champion Frist 2013 Grantor Retained Annuity Trust No. 3, (v) Patricia Champion Frist 2010 Grantor Retained Annuity Trust No. 2 and (vi) Patricia Champion Frist 2011 Grantor Retained Annuity Trust No. 1, each of which her husband serves as trustee, and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Holdings, Inc.
3. The Reporting Person is trustee of (i) Thomas F. Frist, Jr. 2012 Grantor Retained Annuity Trust No. 1, (ii) Thomas F. Frist, Jr. 2012 Grantor Retained Annuity Trust No. 2, (iii) Thomas F. Frist, Jr. 2013 Grantor Retained Annuity Trust, (iv) Thomas F. Frist, Jr. 2010 Grantor Retained Annuity Trust No. 4, (v) Thomas F. Frist, Jr. 2011 Grantor Retained Annuity Trust No. 1, (vi) Frist Children's Trust and (vii) Frist Children's Trust II and may be deemed to be the beneficial owner of the units of Hercules held by these trusts, and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Holdings, Inc.
4. The Reporting Person owns 204,968.4898 units of Hercules and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Holdings, Inc. by virtue of her membership in Hercules. The Reporting Person may also be deemed to to have an indirect beneficial ownership in respect of 60,934.6299 units of Hercules, through an indirect pecuniary interest in such units held by her husband, Dr. Thomas F. Frist, Jr., and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Holdings, Inc.
5. The Reporting Person may be deemed to share voting and dispositive power with respect to 36,629,163.8593 shares of HCA Holdings, Inc. beneficially owned by Frisco, Inc., by virtue of her position as a director of Frisco, Inc. Frisco, Inc. has beneficial ownership of 36,629,163.8593 units of Hercules, and therefore may be deemed to own indirectly the same number of shares of common stock of HCA Holdings, Inc.
Remarks:
/s/ Natalie Harrison Cline, Attorney-in-Fact 02/14/2014
** 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).
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