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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Non-Qualified Stock Option (right to buy) | $ 5.7847 (2) | 02/01/2017 | M | 46,055 | (3) | 11/15/2017 | Common Stock | 46,055 (4) | $ 0 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 5.7847 (2) | 02/01/2017 | M | 8,427 | (5) | 11/15/2017 | Common Stock | 8,427 (4) | $ 0 | 0 | D | ||||
Non-Qualified Stock Option (right to buy) | $ 5.7847 (2) | 02/01/2017 | M | 11,573 | (6) | 11/15/2017 | Common Stock | 11,573 (4) | $ 0 | 26,854 | D | ||||
Stock Appreciation Right | $ 81.96 | 02/01/2017 | A | 25,680 | 02/01/2018(7) | 02/01/2027 | Common Stock | 25,680 | $ 0 | 25,680 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Perlin Jonathan B ONE PARK PLAZA NASHVILLE, TN 37203 |
Pres-Clinical Services & CMO |
/s/ Natalie Harrison Cline, Attorney-in-Fact | 02/03/2017 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Includes 898.2407 shares acquired under the HCA Holdings, Inc. Employee Stock Purchase Plan. |
(2) | Exercise Price was adjusted to reflect a 4.505 to 1 stock split that occurred with respect to the Issuer's common stock effective March 9, 2011. |
(3) | On November 15, 2007, the reporting person was granted an option to purchase 96,055 shares of common stock, which vest upon achievement of certain predetermined investment return targets. 1/3 of the option vested as a result of the achievement of certain specified investment return targets as of the closing of the initial public offering of the Issuer's securities on March 15, 2011, 1/3 of the option vested as a result of the achievement of certain specified investment return targets as of December 31, 2011 and 1/3 of the option vested as a result of the achievement of certain specified investment return targets as of December 31, 2012. |
(4) | Shares have been adjusted to reflect a 4.505 to 1 stock split that occurred with respect to the Issuer's common stock effective March 9, 2011. |
(5) | The option vested in equal increments at the end of fiscal years 2010 and 2011 based upon the achievement of certain annual EBITDA performance targets. |
(6) | The option vested in two equal annual installments beginning on November 15, 2011. |
(7) | The stock appreciation rights vest in four equal annual installments beginning on February 1, 2018. |