Statement of Changes in Beneficial Ownership (4)
May 12 2015 - 4:15PM
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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Ely James S. III
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2. Issuer Name
and
Ticker or Trading Symbol
COMMUNITY HEALTH SYSTEMS INC
[
CYH
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
4000 MERIDIAN BLVD
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3. Date of Earliest Transaction
(MM/DD/YYYY)
5/11/2015
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(Street)
FRANKLIN, TN 37067
(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
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5/11/2015
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G
(1)
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V
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4990
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D
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$0.00
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20227
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D
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Common Stock
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5/11/2015
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G
(1)
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V
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4990
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A
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$0.00
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4990
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I
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By E5 Investors LLC
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Restricted Stock Units
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$0.00
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2/27/2014
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2/26/2023
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Common Stock
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1198
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1198
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D
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Restricted Stock Units
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$0.00
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3/1/2015
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2/29/2024
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Common Stock
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2409
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2409
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D
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Restricted Stock Units
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$0.00
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3/1/2016
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2/28/2025
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Common Stock
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3504
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3504
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D
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Stock Units (SU)
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$0.00
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(2)
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(2)
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Common Stock
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573.833
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573.833
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D
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Explanation of Responses:
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(
1)
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Transfer of shares beneficially owned by Reporting Person to E5 Investors LLC, a Florida limited liability company, owned 20% by Reporting Person, 20% by Reporting Person's spouse, and 60% by family members of Reporting Person who do not share Reporting Person's household. Reporting Person and Reporting Person's spouse serve as managers of E5 Investors LLC. The Reporting Person disclaims beneficial ownership of the Company's common stock held by E5 Investors LLC except to the extent of his pecuniary interest therein.
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(
2)
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The Stock Units were accrued under the Company's Directors' Fees Deferral Plan and are settled 100% in the Company's common stock upon cessation as a director or upon a date specified by the director.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Ely James S. III
4000 MERIDIAN BLVD
FRANKLIN, TN 37067
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X
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Signatures
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Christopher G. Cobb, Attorney in Fact for James S. Ely
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5/12/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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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).
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Note:
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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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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 control number.
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