Sec Form 4 Filing - TCP-ASC ACHI Series LLLP @ R1 RCM Inc. /DE - 2022-09-13

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 TCP-ASC ACHI Series LLLP 2. Issuer Name and Ticker or Trading Symbol R1 RCM Inc. /DE [ RCM] 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) X __ Director X __ 10% Owner _____ Officer (give title below) _____ Other (specify below) (Last) (First) (Middle) 2711 CENTERVILLE ROAD, SUITE 400, 3. Date of Earliest Transaction (MM/DD/YY) 09/13/2022 (Street) WILMINGTON, DE19808 4. If Amendment, Date Original Filed (MM/DD/YY) 6. Individual or Joint/Group Filing (Check Applicable Line) _____ Form filed by One Reporting Person __ X __ 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 09/13/2022 S 15,000,000 D $ 20.425 164,754,055 D( 1 )( 2 )( 3 )( 4 )( 5 )( 6 )

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 Off icer Other TCP-ASC ACHI Series LLLP 2711 CENTERVILLE ROAD, SUITE 400 WILMINGTON, DE19808 X X TCP-ASC GP, LLC 2711 CENTERVILLE ROAD, SUITE 400 WILMINGTON, DE19808 X X TI IV ACHI Holdings GP, LLC 2711 CENTERVILLE ROAD, SUITE 400 WILMINGTON, DE19808 X X TI IV ACHI Holdings, LP 2711 CENTERVILLE ROAD, SUITE 400 WILMINGTON, DE19808 X X TowerBrook Investors, Ltd. C/O TOWERBROOK CAPITAL PARTNERS L.P. 65 EAST 55TH STREET, 19TH FLOOR NEW YORK, NY10022 X X MOSZKOWSKI NEAL C/O TOWERBROOK CAPITAL PARTNERS L.P. 65 EAST 55TH STREET, 19TH FLOOR NEW YORK, NY10022 X X SOUSOU RAMEZ 1 ST. JAMES'S MARKET CARLTON STREET LONDON, X0SW1Y 4AH X X Ascension Health Alliance 101 S. HANLEY ROAD, SUITE 450 ST. LOUIS, MO63105 X X Signatures TCP-ASC ACHI Series LLLP By: TCP-ASC GP, LLC, its General Partner By: /s/ Glenn F. Miller Name: Glenn F. Miller Title: Vice President 09/13/2022 Signature of Reporting Person Date TCP-ASC GP, LLC By: /s/ Glenn F. Miller Name: Glenn F. Miller Title: Vice President 09/13/2022 Signature of Reporting Person Date TI IV ACHI Holdings GP, LLC By: /s/ Glenn F. Miller Name: Glenn F. Miller Title: Vice President 09/13/2022 Signature of Reporting Person Date TI IV ACHI Holdings, LP By: TI IV ACHI Holdings GP, LLC, its General Partner By: /s/ Glenn F. Miller Name: Glenn F. Miller Title: Vice President 09/13/2022 Signature of Reporting Person Date TowerBrook Investors Ltd. By: /s/ Neal Moszkowski Name: Neal Moszkowski Title: Director 09/13/2022 Signature of Reporting Person Date Neal Moszkowski /s/ Neal Moszkowski Neal Moszkowski 09/13/2022 Signature of Reporting Person Date Ramez Sousou /s/ Ramez Sousou Ramez Sousou 09/13/2022 Signature of Reporting Person Date Ascension Health Alliance By: /s/ Christine McCoy Name: Christine McCoy Title: Executive Vice President and General Counsel (authorized signatory) 09/13/2022 Signature of Reporting Person Date

Explanation of Responses:

( 1 )This Form 4 is being filed jointly pursuant to Rule 16a-1(a)(3) and Rule 16a-3(j) under the Securities Act of 1934, as amended (the "Exchange Act") to report the transaction in respect of Common Stock, par value $0.01 per share (the "Common Stock") that TCP-ASC ACHI Series LLLP (the "Partnership"), TCP-ASC GP, LLC (the "Partnership GP"), TI IV ACHI Holdings GP, LLC (the "Aggregator GP"), TI IV ACHI Holdings, LP (the "Aggregator"), TowerBrook Investors Ltd. ("TowerBrook"), Neal Moszkowski, Ramez Sousou, and Ascension Health Alliance d/b/a Ascension ("Ascension") (together, the "Reporting Persons") may be deemed to have beneficially owned and to report beneficial ownership of shares of Common Stock that the Reporting Persons may be deemed to have disposed as a result of the Offering (as defined below). ( 2 )The Partnership is a Delaware series limited liability limited partnership that was formed for the purpose of purchasing, holding, converting, exercising the rights attached to, and disposing of, securities of the Issuer (the "Investment"). The sole general partner of the Partnership is the Partnership GP, and the limited partners of the Partnership are the Aggregator and Ascension. The Partnership GP is a Delaware limited liability company that was formed to effect the Investment. The members of the Partnership GP are the Aggregator and Ascension. ( 3 )The Aggregator is a Delaware limited partnership that was formed to effect the Investment. The sole general partner of the Aggregator is the Aggregator GP, and the limited partners of the Aggregator are TowerBrook Investors IV (Onshore), L.P., TowerBrook Investors IV (OS), L.P., TowerBrook Investors IV Executive Fund, L.P., TowerBrook Investors IV (892), L.P. and TowerBrook Investors Team Daybreak, L.P. The Aggregator GP is a Delaware limited liability company that was formed to effect the Investment. The sole member of the Aggregator GP is TowerBrook. TowerBrook is a Cayman Islands corporation and its principal business is to serve as the general partner or member of various affiliates of investment funds managed or advised by TowerBrook Capital Partners L.P. The directors and joint controlling stockholders of TowerBrook are Neal Moszkowski, a U.S. citizen, and Ramez Sousou, a U.K. citizen. Ascension is a Missouri not-for-profit corporation. ( 4 )The reported securities may be deemed to be owned directly by the Partnership, and indirectly by the Partnership GP, the Aggregator GP, the Aggregator, TowerBrook, Neal Moszkowski, Ramez Sousou and Ascension. As permitted by Rule 16a-1(a)(4), the filing of this Form 4 shall not be construed as an admission that any of the Reporting Persons are beneficial owners of any of the securities covered by this statement. ( 5 )Pursuant to that certain Amended and Restated Limited Liability Limited Partnership Agreement of the Partnership, dated as of June 21, 2022, by and between the Partnership GP, the Aggregator and Ascension (as may be amended, supplemented or otherwise modified from time to time, the "Partnership Agreement"), the board of directors of the Partnership established a series of partnership interests to hold the securities allocable to the Aggregator under the Partnership Agreement ("Series TB") and a series of partnership interests to hold the securities allocable to Ascension under the Partnership Agreement ("Series AS"). ( 6 )On September 13, 2022, the Partnership consummated the sale of an aggregate of 15,000,000 shares of the Common Stock at $20.425 per share pursuant to an underwriting agreement dated September 8, 2022 in connection with a registered public offering (the "Offering"). The Aggregator GP, the Aggregator, TowerBrook, Neal Moszkowski and Ramez Sousou disclaim beneficial ownership of 75,889,325 shares of Common Stock held directly by Series AS following the Offering, whereas Ascension disclaims beneficial ownership of 88,864,730 shares of Common Stock held directly by Series TB following the Offering.

Remarks: For purposes of Section 16 of the Securities Exchange Act of 1934, as amended, the Reporting Persons may be deemed to be directors by deputization by virtue of their contractual right to appoint directors to the board of directors of the Issuer. As a result, the "Director" box is marked in Item 5 of this Form 4.

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).

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