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*
Lane Curtis

(Last) (First) (Middle)
C/O SURGICAL CARE AFFILIATES, INC.,
520 LAKE COOK ROAD, SUITE 250

(Street)
DEERFIELD IL 60015

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Surgical Care Affiliates, Inc. [ SCAI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
04/01/2015
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 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
Common Stock 04/01/2015 M 10,009 A $10.25 16,381(1) D
Common Stock 04/01/2015 S 10,009 D $32.0031(2) 6,372(1) D
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)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Options to Purchase Common Stock $10.25 04/01/2015 M 10,009 (3) 06/24/2015 Common Stock 10,009 $0 1,698 D
Options to Purchase Common Stock $10.25 (4) 09/09/2015 Common Stock 11,707 11,707 D
Options to Purchase Common Stock $10.66 (5) 07/23/2016 Common Stock 11,256 11,256 D
Options to Purchase Common Stock $11.18 (6) 07/01/2020 Common Stock 10,740 10,740 D
Options to Purchase Common Stock $12.1 (7) 07/01/2021 Common Stock 9,921 9,921 D
Explanation of Responses:
1. Includes 6,372 shares of Common Stock underlying Restricted Stock Units ("RSUs") of the issuer. All of the RSUs are subject to time-based vesting. As of April 1, 2015, 3,027 of the RSUs were vested, with the remaining RSUs vesting on the following schedule: 1,168 RSUs vesting on June 30, 2015, 1,009 RSUs vesting on July 1, 2015, and 1,168 RSUs vesting on June 30, 2016. Each vested RSU is settled on the earlier of the individual's termination of employment or a change in control.
2. The price of $32.003125 represents the public offering price of $33.25 per share of Common Stock less the underwriters' discount of $1.246875 per share of Common Stock.
3. The options became vested as to all of the shares of Common Stock underlying such options on June 29, 2008 and became exercisable on September 16, 2013.
4. The options became vested as to all of the shares of Common Stock underlying such options on June 29, 2009 and became exercisable on September 16, 2013.
5. The options became vested as to all of the shares of Common Stock underlying such options on June 29, 2010 and became exercisable on September 16, 2013.
6. The options became vested as to all of the shares of Common Stock underlying such options on June 29, 2011 and became exercisable on September 16, 2013.
7. The options became vested as to all of the shares of Common Stock underlying such options on June 29, 2012 and became exercisable on September 16, 2013.
Remarks:
/s/ Peter J. Clemens, IV, by power of attorney 04/03/2015
** 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.