Statement of Changes in Beneficial Ownership (4)
May 21 2020 - 5:08PM
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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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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
*
Van Horn R. Lawrence |
2. Issuer Name and Ticker or Trading Symbol
Community Healthcare Trust Inc
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CHCT
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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)
C/O COMMUNITY HEALTHCARE TRUST INCORPORA, 3326 ASPEN GROVE DRIVE, SUITE 150 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/21/2020 |
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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 | 5/21/2020 | | A | | 2231 | A | $35.85 (1) | 23745 | D | |
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) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 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 |
| Explanation of Responses: |
| (1) | For 2020, the reporting person elected to take 100% of his Board retainer in the form of shares of restricted stock with a three-year restriction period. Because the reporting person elected to take his Board retainer for 2020 in shares of restricted stock in lieu of cash, the Company awarded him additional shares of restricted stock, equal to 60% of the value of the Board retainer. The price of the securities acquired by the reporting person with respect to the Board retainer is based upon the ten (10) day average stock price of the common stock, which is equal to $35.85. The number of securities issued is equal to the total value of the Board retainer plus the value of the additional shares divided by such 10-day average stock price. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Van Horn R. Lawrence
C/O COMMUNITY HEALTHCARE TRUST INCORPORA
3326 ASPEN GROVE DRIVE, SUITE 150
FRANKLIN, TN 37067 | X |
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Signatures
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| /s/ Christopher M. Douse, Attorney-in-fact | | 5/21/2020 |
| **Signature of Reporting Person | Date |
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