SEC FORM 4 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*
NAGJI BANSI

(Last) (First) (Middle)
C/O CHANGE HEALTHCARE INC.
424 CHURCH STREET, SUITE 1400

(Street)
NASHVILLE TN 37219

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Change Healthcare Inc. [ CHNG ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
04/25/2022
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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 04/25/2022 A 7,658(1) A $0.00 39,280 D
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 (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
Explanation of Responses:
1. Represents the grant of deferred stock units that vest on April 25, 2023. The shares subject to the units will be issued to the Reporting Person after the Reporting Person's separation from service from the Issuer.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney
/s/ Robert Zachary Beasley, as Attorney-in-Fact 04/27/2022
** 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.
POWER OF ATTORNEY


Know all by these presents that the undersigned, does hereby
make, constitute and appoint each of Loretta Cecil, Robert
Zachary Beasley and Elizabeth Way, or any one of them, as a true
and lawful attorney-in-fact of the undersigned with full powers
of substitution and revocation, for and in the name, place and
stead of the undersigned (in the undersigned's individual
capacity), to execute and deliver such forms that the
undersigned may be required to file with the U.S. Securities and
Exchange Commission as a result of the undersigned's ownership
of or transactions in securities of Change Healthcare Inc. (i)
pursuant to Section 16(a) of the Securities Exchange Act of
1934, as amended, including without limitation, statements on
Form 3, Form 4 and Form 5 (including any amendments thereto) and
(ii) in connection with any applications for EDGAR access codes,
including without limitation the Form ID. The Power of Attorney
shall remain in full force and effect until the undersigned is
no longer required to file Forms 3, 4 and 5 with regard to his
or her ownership of or transactions in securities of Change
Healthcare Inc., unless earlier revoked in writing. The
undersigned acknowledges that Loretta Cecil, Robert Zachary
Beasley and Elizabeth Way are not assuming any of the
undersigned's responsibilities to comply with Section 16 of the
Securities Exchange Act of 1934, as amended.


            By: /s/ Bansi Nagji
            Name: Bansi Nagji


            Date: February 2, 2022