Amended Statement of Beneficial Ownership (sc 13d/a)
October 27 2016 - 5:30PM
Edgar (US Regulatory)
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE
13D/A
(Amendment No. 1)
Under the Securities Exchange Act of 1934
USMD
Holdings, Inc.
(Name of Issuer)
Common Stock, par value $.01
(Title of Class of Securities)
903313 104
(CUSIP
Number)
John M. House, M.D.
6333 North State Highway 161, Suite 200
Irving, Texas 75038
Telephone (214) 493-4000
(Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications)
September 30, 2016
(Date
of Event which Requires Filing of this Statement)
If the filing
person has previously filed a statement on Schedule 13G to report the acquisition which is the subject of this Schedule 13D, and is filing this schedule because of §§ 240.13d-1(e), 240.13d-1(f) or 240.13d-1(g), check the following
box ☐.
Note:
Schedules files in paper format shall include a signed original and five copies of the schedule, including all
exhibits.
See
Rule 13d-7 for other parties to whom copies are sent.
The remainder of this cover page
shall be filled out for a reporting persons initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page.
The information required on the remainder of this cover page shall not be deemed to be filed for the purposes of Section 18 of the
Securities Exchange Act of 1934, as amended (the Act) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however,
see
the
Notes
).
SCHEDULE 13D
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CUSIP No. 903313 104
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Page 2 of 4
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1
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NAME OF
REPORTING PERSON
John M. House, M.D.
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER
OF A GROUP
(a) ☐ (b) ☐
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3
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SEC USE ONLY
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4
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SOURCE OF FUNDS
OO
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5
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CHECK BOX IF DISCLOSURE OF LEGAL
PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(D) OR 2(E)
☐
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6
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CITIZENSHIP OR PLACE OF
ORGANIZATION
United States of America
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Number of
Shares
Beneficially
Owned by
Each
Reporting
Person
With
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7
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SOLE VOTING POWER
-0-
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8
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SHARED VOTING POWER
-0-
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9
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SOLE DISPOSITIVE POWER
-0-
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10
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SHARED DISPOSITIVE POWER
-0-
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11
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
-0-
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12
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CHECK BOX IF THE AGGREGATE AMOUNT IN
ROW (11) EXCLUDES CERTAIN SHARES
☐
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13
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PERCENT OF CLASS REPRESENTED BY AMOUNT
IN ROW (11)
0.0%
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14
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TYPE OF REPORTING PERSON
IN
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SCHEDULE 13D
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CUSIP No. 903313 104
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Page 3 of 4
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Explanatory Note
This Amendment No. 1 (this
Amendment
) amends and supplements the Schedule 13D originally filed by John M. House, M.D. (the
Reporting Person
) on September 14, 2012 (the
Original Schedule 13D
), relating to the common stock, par value $0.01 per share (the
Common Stock
), of USMD Holdings, Inc., a Delaware corporation
(
USMD
). The Schedule 13D is hereby amended and supplemented by the Reporting Person as set forth below in this Amendment. Unless set forth below, all previous items of the Original Schedule 13D are unchanged.
Item 2. Identity and Background.
Item 2 of
the Original Schedule 13D is hereby amended and supplemented as follows:
(c) Dr. House served as the Chairman of the Board and Chief
Executive Officer of USMD at the address noted in the Original Schedule 13D until September 30, 2016.
Item 3. Source and Amount of Funds or
Other Consideration
Item 3 of the Original Schedule 13D is hereby amended and supplemented as follows:
The information disclosed in Item 4 is incorporated by reference into this Item 3.
Item 4. Purpose of Transaction
Item 4
of the Original Schedule 13D is hereby amended and supplemented as follows:
On September 30, 2016, USMD completed a previously announced
merger made pursuant to that certain Agreement and Plan of Merger dated August 29, 2016 (the
Merger Agreement
), between USMD, WellMed Medical Management, Inc., a Texas corporation, and Project Z Merger Sub, Inc. (
Merger
Sub
) pursuant to which the Merger Sub merged with and into USMD. At the effective time of the merger, (i) each share of Common Stock outstanding immediately prior to the effective time of the merger, including the shares of Common
Stock held by the Reporting Person, was automatically converted into a right to receive a cash payment of $22.34 per share, and (ii) the options to purchase Common Stock held by the Reporting Person were not exercised but were cancelled as the
exercise price of such options exceeded $22.34 per share.
Item 5. Interest in Securities of the Issuer.
Item 5 of the Original Schedule 13D is hereby amended and supplemented as follows:
(a) (b) As of September 30, 2016, the Reporting Person does not beneficially own any shares of Common Stock.
(c) On September 30, 2016, pursuant to the Merger Agreement, at the effective time of the merger, (i) each share of Common Stock
outstanding immediately prior to the effective time, including the shares of Common Stock held by the Reporting Person, was automatically converted into a right to receive a cash payment of $22.34 per share, and (ii) the options to purchase Common
Stock held by the Reporting Person were not exercised but were cancelled.
(d) Not applicable
(e) The Reporting Person ceased to own more than 5% of the shares of Common Stock on September 30, 2016.
SCHEDULE 13D
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CUSIP No. 903313 104
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Page 4 of 4
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Signature
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true,
complete and correct.
Date: October 27, 2016
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By
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/s/ John M. House, M.D.
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John M. House, M.D.
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