Statement of Changes in Beneficial Ownership (4)
02 April 2021 - 11:07PM
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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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
*
Whitley-Taylor Linda |
2. Issuer Name and Ticker or Trading Symbol
Change Healthcare Inc.
[
CHNG
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) EVP & Chief People Officer |
(Last)
(First)
(Middle)
C/O CHANGE HEALTHCARE INC., 424 CHURCH STREET, SUITE 1400 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
4/1/2021 |
(Street)
NASHVILLE, TN 37219
(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 | 4/1/2021 | | A | | 48245 (1) | A | $0.00 | 89055 (2) | D | |
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) | Represents a grant of restricted stock units that vest as follows: 25% will vest on each of April 1, 2022, 2023, 2024, and 2025. |
(2) | The number of securities reported reflects the acquisition on March 31, 2021 of 529 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. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Whitley-Taylor Linda C/O CHANGE HEALTHCARE INC. 424 CHURCH STREET, SUITE 1400 NASHVILLE, TN 37219 |
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| EVP & Chief People Officer |
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Signatures
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/s/ Carrie Ratliff, as Attorney-in-Fact | | 4/2/2021 |
**Signature of Reporting Person | Date |
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