SEC Form 3
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
|Estimated average burden|
|hours per response:
1. Name and Address of Reporting Person*
|C/O CHANGE HEALTHCARE INC.|
|424 CHURCH STREET, SUITE 1400|
2. Date of Event Requiring Statement
3. Issuer Name and Ticker or Trading Symbol
Change Healthcare Inc.
[ CHNG ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
|SVP and GM, Enterprise Imaging||
5. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||Form filed by One Reporting Person
||Form filed by More than One Reporting Person
|Table I - Non-Derivative Securities Beneficially Owned|
|1. Title of Security (Instr.
Amount of Securities Beneficially Owned (Instr.
||3. Ownership Form: Direct (D) or Indirect (I) (Instr.
||4. Nature of Indirect Beneficial Ownership (Instr.
Table II - Derivative Securities Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Date Exercisable and Expiration Date
||3. Title and Amount of Securities Underlying Derivative Security (Instr.
||4. Conversion or Exercise Price of Derivative Security
||5. Ownership Form: Direct (D) or Indirect (I) (Instr.
||6. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
||/s/ Robert Zachary Beasley, as Attorney-in-Fact
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
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,
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/ Tracy W. Byers
Name: Tracy W. Byers
Date: April 14, 2022