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*
GROSS MURRAY H

(Last) (First) (Middle)
2951 KINWEST PARKWAY

(Street)
IRVING TX 75063

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
US HOME SYSTEMS INC [ USHS ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
3. Date of Earliest Transaction (Month/Day/Year)
12/28/2011
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 12/28/2011 M 1,000 A $2.51 543,464 I See Footnote(1)
Common Stock 12/28/2011 F 347 D $6.34 543,117 I See Footnote(1)
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
Employee Stock Option (right to buy) $2.51 12/28/2011 M 1,000 03/15/2011 03/15/2020 Common Stock 1,000 $0 2,334 I See Footnote(2)
Explanation of Responses:
1. Mr. Gross utilized 347 shares of USHS stock which he owned and cash to pay the exercise price for the 1,000 shares. After all reported transactions, Mr. Gross owns 543,117 shares of common stock which includes 323,493 shares held by About Face, Ltd., 189,690 shares held by BLG Partners, 13,600 owned directly by Mr. Gross, 14,000 shares held in his IRA account and includes presently exercisable options to purchase 2,334 shares. About Face, Ltd. Is a family limited partnership, the partners of which are Mr. Gross and spouse, each of whom own a 49% interest in the partnership, GP About Face Ltd., is the general partner and holds a 1% interest in the partnership. BLG Partners is a general partnership of which Mr. Gross and his spouse are partners. Mr. Gross has sole investment and voting power over the shares owned by both partnerships.
2. After this transaction Mrs. Gross holds vested options to purchase 2,334 shares at $2.51 per share which expire on March 15, 2020.
/s/Murray H. Gross 12/30/2011
** 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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