0001209191-12-059334.txt : 20121226 0001209191-12-059334.hdr.sgml : 20121226 20121226162707 ACCESSION NUMBER: 0001209191-12-059334 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120831 FILED AS OF DATE: 20121226 DATE AS OF CHANGE: 20121226 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Collini M. Patrick CENTRAL INDEX KEY: 0001556961 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-35639 FILM NUMBER: 121285574 MAIL ADDRESS: STREET 1: 1410 LONG AND WINDING ROAD CITY: MANSFIELD STATE: TX ZIP: 76063 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: USMD Holdings, Inc. CENTRAL INDEX KEY: 0001507881 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-GENERAL MEDICAL & SURGICAL HOSPITALS, NEC [8062] IRS NUMBER: 272866866 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 6333 NORTH STATE HIGHWAY 161 STREET 2: SUITE 200 CITY: IRVING STATE: TX ZIP: 75038 BUSINESS PHONE: 214-493-4000 MAIL ADDRESS: STREET 1: 6333 NORTH STATE HIGHWAY 161 STREET 2: SUITE 200 CITY: IRVING STATE: TX ZIP: 75038 4/A 1 c30839_4ax0.xml MAIN DOCUMENT DESCRIPTION X0306 4/A 2012-08-31 2012-09-05 0001507881 USMD Holdings, Inc. USMD 0001556961 Collini M. Patrick 1410 LONG AND WINDING ROAD MANSFIELD TX 76063 1 0 0 0 Common Stock ($.01 par) 2012-08-31 4 J 0 1051 24.84 A 1051 D Common Stock ($.01 par) 2012-08-31 4 J 0 13248 24.84 A 13248 I Held in M. Patrick Collini MD, P.A. Common Stock ($.01 par) 2012-08-31 4 J 0 116650 24.84 A 116650 I Held through UANT Venturees, L.P. Option to purchase 24.84 2012-08-31 4 J 0 1754 0 A 2012-08-31 2017-08-31 Common Stock ($.01 par) 1754 1754 I Indirectly held through UANT Ventures, L.P. The number of shares reported in the original Form 4 was an estimate of the shares to be allocated to the filer pursuant to a Contribution Agreement and was subject to certain post-closing adjustments. Upon completion of the post-closing adjustments, the number of shares the filer actually received pursuant to the Contribution Agreement was 1,051. The price per share reported in the original Form 4 was an estimate of the share price based upon the estimated value of the assets contributed to the issuer pursuant to a Contribution Agreement and was subject to certain post-closing adjustments. Upon completion of the post-closing adjustments, the price per share was calculated to be $24.84. The number of shares reported in the original Form 4 was an estimate of the shares to be allocated to the filer pursuant to a Contribution Agreement and was subject to certain post-closing adjustments. Upon completion of the post-closing adjustments, the number of shares the filer actually received pursuant to the Contribution Agreement was 13,248. These shares were inadvertantly omitted from the original Form 4. The exercise price reported in the original Form 4 was an estimate of the exercise price of the options to be issued to the filer pursuant to a Contribution Agreement and was subject to certain post-closing adjustments. Upon completion of the post-closing adjustments, the exercise price was calculated to be $24.84. The number of options reported in the original Form 4 was an estimate of the number of options to be granted to the filer pursuant to a Contribution Agreement and was subject to certain post-closing adjustments. Upon completion of the post-closing adjustments, the number of options the filer actually received pursuant to the Contribution Agreement was 1,754. /s/ M. Patrick Collini 2012-12-26