0001127602-16-052445.txt : 20160517 0001127602-16-052445.hdr.sgml : 20160517 20160517142415 ACCESSION NUMBER: 0001127602-16-052445 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160517 FILED AS OF DATE: 20160517 DATE AS OF CHANGE: 20160517 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: UNIVERSAL HEALTH REALTY INCOME TRUST CENTRAL INDEX KEY: 0000798783 STANDARD INDUSTRIAL CLASSIFICATION: REAL ESTATE INVESTMENT TRUSTS [6798] IRS NUMBER: 236858580 STATE OF INCORPORATION: MD FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: UNIVERSAL CORPORATE CTR STREET 2: 367 S GULPH RD CITY: KING OF PRUSSIA STATE: PA ZIP: 19406 BUSINESS PHONE: 610-265-0688 MAIL ADDRESS: STREET 1: UNIVERSAL CORPORATE CTR STREET 2: 367 S GULPH ROAD CITY: KING OF PRUSSIA STATE: PA ZIP: 19406 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SUSSMAN ELLIOT J MD MBA CENTRAL INDEX KEY: 0001181000 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09321 FILM NUMBER: 161657034 4 1 form4.xml PRIMARY DOCUMENT X0306 4 2016-05-17 0000798783 UNIVERSAL HEALTH REALTY INCOME TRUST UHT 0001181000 SUSSMAN ELLIOT J MD MBA HEALTH IN THE VILLAGES 1020 LAKE SUMTER LANDING THE VILLAGES FL 32162 1 Trustee Shares Of Beneficial Interest 2016-05-17 4 M 0 1000 55.71 A 6825 D Option To Purchase Shares Of Beneficial Interest 36.53 2016-05-17 4 M 0 1000 0 D 2017-03-01 Shares Of Beneficial Interest 1000 0 D The option vested ratably on each of 3/1/2008, 3/1/2009, 3/1/2010 and 3/1/2011. The reporting person has also been granted Dividend Equivalent Rights on the same terms as the options, pursuant to which the reporting person will receive the accrued cash dividends upon exercise of the Dividend Equivalent Rights. /s/ Charles F. Boyle, Attorney-in-Fact for Mr. Sussman 2016-05-17