Statement of Changes in Beneficial Ownership (4)
March 20 2020 - 5:15PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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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1. Name and Address of Reporting Person
*
ORTENZIO ROBERT A |
2. Issuer Name and Ticker or Trading Symbol
SELECT MEDICAL HOLDINGS CORP
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SEM
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Exec. Chairman and Co-Founder |
(Last)
(First)
(Middle)
C/O SELECT MEDICAL HOLDINGS CORPORATION, 4714 GETTYSBURG ROAD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/19/2020 |
(Street)
MECHANICSBURG, PA 17055
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 3/19/2020 | | G |
V
| 300000 | D | $0 | 6093036 | D | |
Common Stock | | | | | | | | 1900000 (1) | I | By the Robert A. Ortenzio Descendants Trust (2) |
Common Stock | | | | | | | | 3150000 | I | By the Rocco A. Ortenzio Descendants Trust (2) |
Common Stock | | | | | | | | 56669 | I | By the Rocco A. Ortenzio 2014 Trust for Robert A. Ortenzio (2) |
Common Stock | | | | | | | | 800000 | I | By the Robert A. Ortenzio October 2019 GRAT (2) |
Common Stock | | | | | | | | 54553 | I | By the Robert A. Ortenzio 2014 Trust for Bryan A. Ortenzio (2) |
Common Stock | | | | | | | | 54553 | I | By the Robert A. Ortenzio 2014 Trust for Kevin M. Ortenzio (2) |
Common Stock | | | | | | | | 54552 | I | By the Robert A. Ortenzio 2014 Trust for Madeline G. Ortenzio (2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Explanation of Responses: |
(1) | 300,000 shares were previously owned by, and contributed by, Robert A. Ortenzio to the Robert A. Ortenzio Descendants Trust. |
(2) | The reporting person beneficially owns the reported securities indirectly, but disclaims beneficial ownership to the reported securities except to the extent of his pecuniary interest therein. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
ORTENZIO ROBERT A C/O SELECT MEDICAL HOLDINGS CORPORATION 4714 GETTYSBURG ROAD MECHANICSBURG, PA 17055 | X |
| Exec. Chairman and Co-Founder |
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Signatures
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/s/ Michael E. Tarvin, as attorney-in-fact | | 3/20/2020 |
**Signature of Reporting Person | Date |
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