0001104659-15-059652.txt : 20150813 0001104659-15-059652.hdr.sgml : 20150813 20150813180446 ACCESSION NUMBER: 0001104659-15-059652 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150811 FILED AS OF DATE: 20150813 DATE AS OF CHANGE: 20150813 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Community Healthcare Trust Inc CENTRAL INDEX KEY: 0001631569 STANDARD INDUSTRIAL CLASSIFICATION: REAL ESTATE INVESTMENT TRUSTS [6798] IRS NUMBER: 465212033 STATE OF INCORPORATION: MD FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 354 COOL SPRINGS BLVD. STREET 2: SUITE 106 CITY: FRANKLIN STATE: TN ZIP: 37067 BUSINESS PHONE: 615-771-3052 MAIL ADDRESS: STREET 1: 354 COOL SPRINGS BLVD. STREET 2: SUITE 106 CITY: FRANKLIN STATE: TN ZIP: 37067 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WALLACE TIMOTHY G CENTRAL INDEX KEY: 0001210485 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37401 FILM NUMBER: 151051926 4 1 a4.xml 4 X0306 4 2015-08-11 0 0001631569 Community Healthcare Trust Inc CHCT 0001210485 WALLACE TIMOTHY G C/O COMMUNITY HEALTHCARE TRUST INC 354 COOL SPRINGS BLVD., SUITE 106 FRANKLIN TN 37067 1 1 0 0 Chairman, CEO & President Common Stock 2015-08-11 4 A 0 18853 0.00 A 124116 D Common Stock 120000 I See Footnote The amount shown represents the beneficial ownership of the Issuer's securities by Athena Funding Partners, LLC ("AFP"). Mr. Wallace owns 99% of AFP and disclaims beneficial ownership of the securities to the extent it exceeds his pecuniary interest therein and the inclusion of the shares in this report shall not be deemed to be an admission of beneficial ownership of the reported shares for the purposes of Section 16 of the Exchange Act or otherwise. /s/ Christopher Douse, Attorney-in-Fact 2015-08-13