-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, M5EYjFDPT5jaBed24LID6QqysCXm9Bd1Xcb8QHrSF4kaD+ZYXBWixNzJkVjyasON VORl2vkPfMy1iLAhh3vgfw== /in/edgar/work/0000769993-00-000568/0000769993-00-000568.txt : 20001121 0000769993-00-000568.hdr.sgml : 20001121 ACCESSION NUMBER: 0000769993-00-000568 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000630 FILED AS OF DATE: 20001120 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: QUORUM HEALTH GROUP INC CENTRAL INDEX KEY: 0000854694 STANDARD INDUSTRIAL CLASSIFICATION: [8062 ] IRS NUMBER: 621406040 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-22766 FILM NUMBER: 772979 BUSINESS ADDRESS: STREET 1: 103 CONTINENTAL PL CITY: BRENTWOOD STATE: TN ZIP: 37027 BUSINESS PHONE: 6153717979 MAIL ADDRESS: STREET 1: 103 CONTINENTAL PL CITY: BRENTWOOD STATE: TN ZIP: 37027 FORMER COMPANY: FORMER CONFORMED NAME: HMC HOLDINGS CORP DATE OF NAME CHANGE: 19900701 COMPANY DATA: COMPANY CONFORMED NAME: MURPHY JR THOMAS S CENTRAL INDEX KEY: 0001029626 STANDARD INDUSTRIAL CLASSIFICATION: [ ]DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 85 BROAD STREET CITY: NEW YORK STATE: NY ZIP: 10004 BUSINESS PHONE: 2129027202 MAIL ADDRESS: STREET 1: 85 BROAD STREET CITY: NEW YORK STATE: NY ZIP: 10004 5 1 0001.txt ANNUAL STATEMENT/CHANGES IN BENEFICIAL OWNERSHIP UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 5 ANNUAL 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(f) of the Investment Company Act of 1940 [ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [ ] Form 3 Holdings Reported [ ] Form 4 Transactions Reported ================================================================================ 1. Name and Address of Reporting Person* Murphy, Jr., Thomas S. - -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o Goldman, Sachs & Co. 85 Broad Street - -------------------------------------------------------------------------------- (Street) New York, NY 10004 - -------------------------------------------------------------------------------- (City) (State) (Zip) ================================================================================ 2. Issuer Name and Ticker or Trading Symbol Quorum Health Group, Inc. (QHGI) ================================================================================ 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) ================================================================================ 4. Statement for Month/Year FYE June 30, 2000 ================================================================================ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [ X ] Director [ ] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) -------------------------------------------------- ================================================================================ 7. Individual or Joint/Group Reporting (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 | ==================================================================================================================================== | | | | | | | | | | |5. |6. | | | | |4. |Amount of |Owner- | | | | |Securities Acquired (A) or |Securities |ship | | | | |Disposed of (D) |Beneficially |Form: |7. | | | |(Instr. 3, 4 and 5) |Owned at end |Direct |Nature of | |2. | 3. |-------------------------------|of Issuer's |(D) or |Indirect | 1. |Transaction |Transaction | | (A) | |Fiscal Year |Indirect |Beneficial| Title of Security |Date |Code | Amount | or | Price |(Instr. 3 |(I) |Ownership | (Instr. 3) |(mm/dd/yy) |(Instr. 8) | | (D) | |and 4) |(Instr.4)|(Instr. 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). FORM 5 (continued)
==================================================================================================================================== Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned | (e.g., puts, calls, warrants, options, convertible securities) | ==================================================================================================================================== | | | | | | | | | | | | | | | | | | |9. |10. | | | | | | | | | |Number |Owner-| | | | | | | | | |of |ship | | |2. | | | | | | |Deriv- |of | | |Conver-| | |5. | |7. | |ative |Deriv-|11. | |sion | | |Number of | |Title and Amount | |Secur- |ative |Nature| |or | | |Derivative |6. |of Underlying |8. |ities |Secur-|of | |Exer- | | |Securities |Date |Securities |Price |Bene- |ity: |In- | |cise |3. | |Acquired (A) |Exercisable and |(Instr. 3 and 4) |of |ficially |Direct|direct| |Price |Trans- |4. |or Disposed |Expiration Date |--------------------|Deriv- |Owned |(D) or|Bene- | 1. |of |action |Trans-|of (D) |(Month/Day/Year) | |Amount |ative |at End |In- |ficial| Title of |Deriv- |Date |action|(Instr. 3, |---------------------| |or |Secur- |of |direct|Owner-| Derivative |ative |(Month/ |Code |4 and 5) |Date |Expira- | |Number |ity |Year |(I) |ship | Security |Secur- |Day/ |(Instr|---------------|Exer- |tion | |of |(Instr.|(Instr. |(Instr|(Instr| (Instr. 3) |ity |Year) |8) | (A) |(D) |cisable |Date |Title |Shares |5) |4) |4) |4) | - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option | | | | | | | | | | | | | | (right to buy)|$12.56 | 07/01/99 | A | 5,001 | | 01 | 07/01/04 |Common Stock| 5,001 | | 5,001 | D | | - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option | | | | | | | | | | | | | | (right to buy)|$17.50 | | | | | 01 | 07/01/01 |Common Stock| 5,001 | | 5,001 | D(02)| | - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option | | | | | | | | | | | | | | (right to buy)|$24.00 | | | | | 01 | 07/01/02 |Common Stock| 5,001 | | 5,001 | D | | - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option | | | | | | | | | | | | | | (right to buy)|$27.13 | | | | | 01 | 07/01/03 |Common Stock| 5,001 | | 5,001 | D | | ====================================================================================================================================
Explanation of Responses: 01: These options were granted to the Reporting Person under the Quorum Health Group, Inc. Directors Stock Option Plan, qualified under Rule 16b-3. The options were granted on 7/1/99, 7/1/96, 7/1/97 and 7/1/98, respectively; they each become exercisable in four equal annual installments commencing one year after the respective date of grant. 02: The Reporting Person is a managing director of Goldman, Sachs & Co. ("Goldman Sachs"). Goldman Sachs is an indirect wholly-owned subsidiary of The Goldman Sachs Group, Inc. ("GS Group"). The Reporting Person has an agreement with GS Group pursuant to which he holds these stock options for the benefit of GS Group. The Reporting Person does not have any pecuniary interest in the stock options and accordingly, disclaims beneficial ownership thereof. By: s/ Roger S. Begelman November 8, 2000 - --------------------------------------------- ----------------------- **Signature of Reporting Person Date Attorney-in-fact ** 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 provided is insufficient, see Instruction 6 for procedure. Alternatively, this Form is permitted to be submitted to the Commission in electronic format at the option of the Reporting Person pursuant to Rule 101(b)(4) of Regulation S-T. -----END PRIVACY-ENHANCED MESSAGE-----