0001567619-19-006750.txt : 20190312 0001567619-19-006750.hdr.sgml : 20190312 20190312190953 ACCESSION NUMBER: 0001567619-19-006750 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20190308 FILED AS OF DATE: 20190312 DATE AS OF CHANGE: 20190312 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KIRSHNER BENJAMIN A. CENTRAL INDEX KEY: 0001757306 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19364 FILM NUMBER: 19676476 MAIL ADDRESS: STREET 1: 600 OFFICE CENTER DRIVE CITY: FORT WASHINGTON STATE: PA ZIP: 19034 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: TIVITY HEALTH, INC. CENTRAL INDEX KEY: 0000704415 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 621117144 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 701 COOL SPRINGS BOULEVARD CITY: FRANKLIN STATE: TN ZIP: 37067 BUSINESS PHONE: 6156144929 MAIL ADDRESS: STREET 1: 701 COOL SPRINGS BOULEVARD CITY: FRANKLIN STATE: TN ZIP: 37067 FORMER COMPANY: FORMER CONFORMED NAME: HEALTHWAYS, INC. DATE OF NAME CHANGE: 20170104 FORMER COMPANY: FORMER CONFORMED NAME: TIVITY HEALTH, INC DATE OF NAME CHANGE: 20161230 FORMER COMPANY: FORMER CONFORMED NAME: HEALTHWAYS, INC DATE OF NAME CHANGE: 20060201 3 1 doc1.xml FORM 3 X0206 3 2019-03-08 1 0000704415 TIVITY HEALTH, INC. TVTY 0001757306 KIRSHNER BENJAMIN A. 600 OFFICE CENTER DRIVE FORT WASHINGTON PA 19034 1 0 0 0 Exhibit List: Exhibit 24.1 - Power of Attorney /s/ Mary Flipse, by power of attorney for Benjamin A. Kirshner 2019-03-12 EX-24.1 2 poa_kirshner.htm
POWER OF ATTORNEY
 
Know all by these presents, that the undersigned hereby constitutes and appoints Adam Holland and Mary Flipse, signing singly, the undersigned’s true and lawful attorney-in-fact to:
 
 
(1)  
execute for and on behalf of the undersigned, in the undersigned’s capacity as an officer and/or director of Tivity Health, Inc. (the “Company”), any Form ID, or successor forms, and amendments thereto, for access codes to the Securities and Exchange Commission’s EDGAR system, or any successor system, and any Forms 3, 4, and 5 and any other reports or forms the undersigned may be required to file in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder;
 
 
(2)  
do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form ID, or successor forms, or Form 3, 4, or 5, or any other reports or forms the undersigned may be required to file in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder, complete and execute any amendment or amendments thereto, and timely file such form or report with the United States Securities and Exchange Commission and any stock exchange or similar authority; and
 
 
(3)  
take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in such attorney-in-fact’s discretion.
 
 
The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or such attorney-in-fact’s substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted.  The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned’s responsibilities to comply with Section 16 of the Securities Exchange Act of 1934.
 
 
This 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 respect to the undersigned’s holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact.
 
 
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 5th day of March, 2019.
 
/s/ Benjamin Kirshner       
Signature

Benjamin Kirshner           
Print Name