SEC Form 4
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 | OMB APPROVAL | |
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP | ||
OMB Number: | 3235-0287 | |
Estimated average burden | ||
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 | hours per response: | 0.5 |
or Section 30(h) of the Investment Company Act of 1940 |
1. Name and Address of Reporting Person* | 2. Issuer Name and Ticker or Trading Symbol | 5. Relationship of Reporting Person(s) to Issuer | ||||||||||||||||||||||||||||||||
De Crescenzo Neil E. | Change Healthcare Inc.[ CHNG ] | (Check all applicable) | ||||||||||||||||||||||||||||||||
X | Director | 10% Owner | ||||||||||||||||||||||||||||||||
X | Officer (give title | Other (specify | ||||||||||||||||||||||||||||||||
(Last) | (First) | (Middle) | 3. Date of Earliest Transaction (Month/Day/Year) | below) | below) | |||||||||||||||||||||||||||||
C/O CHANGE HEALTHCARE INC. | 04/01/2021 | President & CEO | ||||||||||||||||||||||||||||||||
424 CHURCH STREET, SUITE 1400 | ||||||||||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable | |||||||||||||||||||||||||||||||||
(Street) | Line) | |||||||||||||||||||||||||||||||||
X Form filed by One Reporting Person | ||||||||||||||||||||||||||||||||||
NASHVILLE TN | 37219 | |||||||||||||||||||||||||||||||||
Form filed by More than One Reporting | ||||||||||||||||||||||||||||||||||
(City) | (State) | (Zip) | Person | |||||||||||||||||||||||||||||||
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||||||||||||||||||||||||||
1. Title of Security (Instr. 3) | 2. Transaction | 2A. Deemed | 3. | 4. Securities Acquired (A) or | 5. Amount of | 6. Ownership | 7. Nature | |||||||||||||||||||||||||||
Date | Execution Date, | Transaction | Disposed Of (D) (Instr. 3, 4 and | Securities | Form: Direct | of Indirect | ||||||||||||||||||||||||||||
(Month/Day/Year) | if any | Code (Instr. | 5) | Beneficially | (D) or Indirect | Beneficial | ||||||||||||||||||||||||||||
(Month/Day/Year) | 8) | Owned Following | (I) (Instr. 4) | Ownership | ||||||||||||||||||||||||||||||
Reported | (Instr. 4) | |||||||||||||||||||||||||||||||||
Code | V | Amount | (A) or | Price | Transaction(s) | |||||||||||||||||||||||||||||
(D) | (Instr. 3 and 4) | |||||||||||||||||||||||||||||||||
Common Stock | 04/01/2021 | A | 289,473(1) | A | $0.00 | 737,334(2) | D | |||||||||||||||||||||||||||
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||||||||||||||||||||||||||
(e.g., puts, calls, warrants, options, convertible securities) | ||||||||||||||||||||||||||||||||||
1. Title of | 2. | 3. Transaction | 3A. Deemed | 4. | 5. Number | 6. Date Exercisable and | 7. Title and | 8. Price of | 9. Number of | 10. | 11. Nature | |||||||||||||||||||||||
Derivative | Conversion | Date | Execution Date, | Transaction | of | Expiration Date | Amount of | Derivative | derivative | Ownership | of Indirect | |||||||||||||||||||||||
Security | or Exercise | (Month/Day/Year) | if any | Code (Instr. | Derivative | (Month/Day/Year) | Securities | Security | Securities | Form: | Beneficial | |||||||||||||||||||||||
(Instr. 3) | Price of | (Month/Day/Year) | 8) | Securities | Underlying | (Instr. 5) | Beneficially | Direct (D) | Ownership | |||||||||||||||||||||||||
Derivative | Acquired | Derivative | Owned | or Indirect | (Instr. 4) | |||||||||||||||||||||||||||||
Security | (A) or | Security (Instr. | Following | (I) (Instr. 4) | ||||||||||||||||||||||||||||||
Disposed | 3 and 4) | Reported | ||||||||||||||||||||||||||||||||
of (D) | Transaction(s) | |||||||||||||||||||||||||||||||||
(Instr. 3, 4 | (Instr. 4) | |||||||||||||||||||||||||||||||||
and 5) | ||||||||||||||||||||||||||||||||||
Amount | ||||||||||||||||||||||||||||||||||
or | ||||||||||||||||||||||||||||||||||
Number | ||||||||||||||||||||||||||||||||||
Date | Expiration | of | ||||||||||||||||||||||||||||||||
Code | V | (A) | (D) | Exercisable | Date | Title | Shares | |||||||||||||||||||||||||||
Explanation of Responses:
- Represents a grant of restricted stock units that vest as follows: 25% will vest on each of April 1, 2022, 2023, 2024, and 2025.
- The number of securities reported reflects the acquisition on March 31, 2021 of 1,674 shares of Change Healthcare Inc.'s common stock pursuant to the Change Healthcare Inc. Employee Stock Purchase Plan ("ESPP") for the ESPP purchase period of October 1, 2020 through March 31, 2021.
/s/ Carrie Ratliff, as Attorney- 04/02/2021 in-Fact
** 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).
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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Change Healthcare Inc. published this content on 02 April 2021 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 04 April 2021 18:43:02 UTC.