Sec Form 4 Filing - COMMUNITY HEALTH SYSTEMS INC @ Quorum Health Corp - 2016-04-29

Insider filing report for Changes in Beneficial Ownership
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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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
COMMUNITY HEALTH SYSTEMS INC
2. Issuer Name and Ticker or Trading Symbol
Quorum Health Corp [ QHC]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
4000 MERIDIAN BOULEVARD
3. Date of Earliest Transaction (MM/DD/YY)
04/29/2016
(Street)
FRANKLIN, TN37067
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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, par value $0.0001 per share 04/29/2016 J( 1 ) 28,438,547 ( 2 ) D $ 0 0 I Held through CHS-QHC Bridge Company, LLC ( 3 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
COMMUNITY HEALTH SYSTEMS INC
4000 MERIDIAN BOULEVARD
FRANKLIN, TN37067
X
Signatures
/s/ Jay H. Knight, Attorney in Fact for Rachel A. Seifert, EVP and Corporate Secretary 04/29/2016
Signature of Reporting Person Date
Explanation of Responses:
( 1 )In connection with the spin-off of Quorum Health Corporation ("QHC") by Community Health Systems, Inc. ("CHS"), on April 29, 2016, CHS distributed 100% of the outstanding shares of common stock, $0.0001 par value, of QHC owned by CHS to the holders of CHS common stock as of the close of business on April 22, 2016, the record date for the distribution.
( 2 )In connection with the spin-off of QHC by CHS, on April 29, 2016, QHC effected a forward stock split, which resulted in the reporting person's ownership of 1,000 shares being converted into 28,438,547 shares.
( 3 )These shares were owned indirectly through CHS-QHC Bridge Company, LLC, a Delaware limited liability company, which is a wholly-owned subsidiary of CHS/Community Health Systems, Inc., a Delaware corporation, which is a wholly-owned subsidiary of CHS.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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