SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Change Healthcare Inc. [ CHNG ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 08/20/2020 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) 12/30/2021 | 6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 08/20/2020 | M | 7,704 | A | (4) | 115,022 | D | |||
Common Stock | 08/20/2020 | D | 7,704 | D | $12.93 | 107,318 | D | |||
Common Stock | 06/17/2021 | M | 10,974 | A | (4) | 118,292 | D | |||
Common Stock | 06/17/2021 | D | 10,974 | D | $23.07 | 107,318 | D | |||
Common Stock | 08/01/2021 | M | 7,704 | A | (4) | 115,865 | D | |||
Common Stock | 08/01/2021 | D | 7,704 | D | $21.71 | 107,318 | D | |||
Common Stock | 12/28/2021 | M(2) | 7,704(1) | A | (4) | 115,022(1) | D | |||
Common Stock | 12/28/2021 | D(2) | 7,704(1) | D | $21.44 | 107,318(1) | D | |||
Common Stock | 12/28/2021 | F | 11,301(2) | D | $21.44 | 96,017(2) | D | |||
Common Stock | 12/29/2021 | M | 57,657 | A | $11.6 | 153,674(3) | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 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: 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 | ||||||||
Cash-Settled Restricted Stock Units | (4) | 08/20/2020 | M | 7,704 | (5) | (5) | Common Stock | 7,704 | $0.00 | 15,408 | D | ||||
Cash-Settled Restricted Stock Units | (4) | 06/17/2021 | M | 10,974 | (6) | (6) | Common Stock | 10,974 | $0.00 | 0 | D | ||||
Cash-Settled Restricted Stock Units | (4) | 08/01/2021 | M | 7,704 | (5) | (5) | Common Stock | 7,704 | $0.00 | 7,704 | D | ||||
Cash-Settled Restricted Stock Units | (4) | 12/28/2021 | M | 7,704 | (5) | (5) | Common Stock | 7,704 | $0.00 | 0 | D |
Explanation of Responses: |
1. The original Form 4, filed on December 30, 2021 (the "December Form 4") is being amended to report the acquisition and disposition of shares in connection with the cash settlement of certain previously awarded RSUs. |
2. The December Form 4, is being amended to remove the transaction reporting the acquisition of underlying certain RSUs, as such shares had already previously been reported at the time of grant of the RSUs, and to correct the number of shares withheld from the shares deliverable upon vesting of the RSUs to satisfy tax withholding requirements, as well as the amount of securities beneficially owned following the reported transaction. |
3. The December Form 4 is being amended to correct the amount of securities beneficially owned following the reported transaction, as a result of the corrections noted above. |
4. Each cash-settled restricted stock unit represents the contingent right to receive the cash value of one share of the Company's Common Stock upon vesting. |
5. Pursuant to a grant on August 20, 2019, whereby (a) one-third to vests on each of August 1, 2021 and 2022 and (b) one-third vests on August 1, 2021, subject to accelerated vesting based on certain events. In connection with the anticipated transactions contemplated by the Agreement and Plan of Merger whereby the Issuer will be acquired by UnitedHealth Group Incorporated, the Compensation Committee of the Board of Directors of the Issuer accelerated the August 1, 2022 vesting date. |
6. Pursuant to a grant on June 17, 2020, these cash-settled restricted stock units vested in full on June 17, 2021. |
Remarks: |
Exhibit List: Exhibit 24 - Power of Attorney |
/s/ Robert Zachary Beasley, as Attorney-in-Fact | 02/25/2022 | |
** 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). | ||
** 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. | ||
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 Number. |