Initial Statement of Beneficial Ownership (3)
October 15 2019 - 12:07PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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STAFFIERI MICHAEL DAVID |
2. Date of Event Requiring Statement (MM/DD/YYYY)
10/4/2019
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3. Issuer Name and Ticker or Trading Symbol
DAVITA INC. [DVA]
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(Last)
(First)
(Middle)
C/O DAVITA INC., 2000 16TH STREET |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
Chief Operating Officer, DKC / |
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(Street)
DENVER, CO 80202
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 Beneficially Owned
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1.Title of Security
(Instr. 4) | 2. Amount of Securities Beneficially Owned
(Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) | 4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Common Stock | 86945 (1) | D | |
| Common Stock | 47315 | I | by 2012 Staffieri Family Trust |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) | 6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Stock Appreciation Rights | (2) | 6/2/2020 | Common Stock | 40284.0 | $83.82 | D | |
| Stock Appreciation Rights | (3) | 5/13/2021 | Common Stock | 66477.0 | $75.42 | D | |
| Stock Appreciation Rights | (4) | 6/6/2022 | Common Stock | 74201.0 | $65.48 | D | |
| Stock Appreciation Rights | (5) | 5/15/2023 | Common Stock | 243994.0 | $66.29 | D | |
| Common Stock | (6) | 6/20/2024 | Common Stock | 200000.0 | $52.41 | D | |
| Explanation of Responses: |
| (1) | Includes (i) 79,650 restricted stock units granted on May 15, 2019, which are scheduled to vest 50% each on May 15, 2022 and May 15, 2023, respectively, and (ii) 4,093 restricted stock units granted on December 24, 2016, which are scheduled to vest in full on May 15, 2020. Each of the foregoing vestings is subject to continued service through each applicable vesting date. |
| (2) | The Stock Appreciation Rights were granted on June 2, 2015, and are fully vested as of the date hereof. |
| (3) | The Stock Appreciation Rights were granted on May 13, 2016, with 50% having vested on May 13, 2019 and the remaining 50% scheduled to vest on May 13, 2020, subject to continued service through the applicable vesting date. |
| (4) | The Stock Appreciation Rights were granted on June 6, 2017, and are scheduled to vest 50% each on May 15, 2020 and May 15, 2021, respectively, subject to continued service through the applicable vesting date. |
| (5) | The Stock Appreciation Rights were granted on May 15, 2018, and are scheduled to vest 50% each on May 15, 2021 and May 15, 2022, respectively, subject to continued service through the applicable vesting date. |
| (6) | The Stock Appreciation Rights were granted on June 20, 2019, and are scheduled to vest 50% each on June 20, 2021 and June 20, 2023, respectively, subject to continued service through the applicable vesting date. |
Remarks:
Exhibit List
Exhibit 24 - Power of Attorney |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
STAFFIERI MICHAEL DAVID
C/O DAVITA INC.
2000 16TH STREET
DENVER, CO 80202 |
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| Chief Operating Officer, DKC |
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Signatures
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| /s/ Stephanie N. Berberich, Attorney-in-Fact | | 10/15/2019 |
| **Signature of Reporting Person | Date |
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