SEC Form 4 · accession 0001209191-17-016532
COMMUNITY HEALTH SYSTEMS INC · CYH
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
James S. Ely III
Director
Period of report
Mar 1, 2017
Accepted (ET)
Mar 2, 2017 · 4:12 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001108109
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Mar 1, 2017 | M | 1,474 | $0.00 | A | 45,272 | D | |
| Common StockF1 | Mar 1, 2017 | M | 1,430 | $0.00 | A | 46,702 | D | |
| Common StockF1 | Mar 1, 2017 | M | 4,495 | $0.00 | A | 51,197 | D | |
| Common Stock | holding | — | — | — | 4,990 | I | By E5 Investors LLC |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Restricted Stock Units | $0.00 | Mar 1, 2017 | M | 1,474 | D | Mar 1, 2015 | Feb 29, 2024 | Common Stock | 1,474 | 0 | D |
| Restricted Stock Units | $0.00 | Mar 1, 2017 | M | 1,430 | D | Mar 1, 2016 | Feb 28, 2025 | Common Stock | 1,430 | 1,429 | D |
| Restricted Stock Units | $0.00 | Mar 1, 2017 | M | 4,495 | D | Mar 1, 2017 | Feb 28, 2026 | Common Stock | 4,495 | 8,989 | D |
| Restricted Stock UnitsF1,F2 | $0.00 | Mar 1, 2017 | A | 18,498 | A | Mar 1, 2018 | Feb 28, 2027 | Common Stock | 18,498 | 18,498 | D |
| Stock Units (SU)F3 | $0.00 | holding | — | — | — | — | — | Common Stock | 15,968 | 15,968 | D |
Explanation of responses
- F1The security converts to common stock on a one-to-one basis.
- F2The Restricted Stock Units vest in 1/3 increments on the first, second and third anniversary date of the date of grant. Upon vesting, the Reporting Person will be issued that number of shares of the Common Stock of the Company.
- F3The Stock Units were accrued under the Company's Directors' Fees Deferral Plan in lieu of a portion of the Reporting Person's Director Fees and are settled 100% in the Company's common stock upon cessation as a director or upon a date specified by the director.
Remarks
NOTE: The number of restricted stock units and stock units accrued under the Company's Directors' Fees Deferral Plan for each award listed on Table II granted prior to April 29, 2016, was adjusted pursuant to the Employee Matters Agreement between the Issuer and Quorum Health Corporation ("QHC"), dated as of April 29, 2016, to preserve the aggregate intrinsic value of the original award as a result of the spin-off from the Issuer of QHC, effective April 29, 2016.