0001209191-12-059336.txt : 20121226 0001209191-12-059336.hdr.sgml : 20121226 20121226162916 ACCESSION NUMBER: 0001209191-12-059336 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: House John M. CENTRAL INDEX KEY: 0001556843 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-35639 FILM NUMBER: 121285588 MAIL ADDRESS: STREET 1: 1713 DOWLING DRIVE CITY: IRVING STATE: TX ZIP: 75038 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 c30835_4ax0.xml MAIN DOCUMENT DESCRIPTION X0306 4/A 2012-08-31 2012-09-06 0001507881 USMD Holdings, Inc. USMD 0001556843 House John M. 1713 DOWLING DRIVE IRVING TX 75038 1 1 1 0 Chief Executive Officer Common Stock ($.01 par) 2012-08-31 4 J 0 39551 24.84 A 39551 D Common Stock ($.01 par) 2012-08-31 4 J 0 13248 24.84 A 13248 I Held through John M. House MD, P.A. Common Stock ($.01 par) 2012-08-31 4 J 0 743920 24.84 A 743920 I Held through UANT Ventures, L.P. Option to purchase 24.84 2012-08-31 4 J 0 1754 0 A 2012-08-31 2017-08-31 Common Stock ($.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 39,551. 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. 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 743,920. 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/ John M. House 2012-12-26