SEC Form 3
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
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1. Name and Address of Reporting Person*
DILL DAVID M

(Last) (First) (Middle)
C/O R1 RCM INC.
434 W. ASCENSION WAY, 6TH FLOOR

(Street)
MURRAY UT 84123

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/21/2022
3. Issuer Name and Ticker or Trading Symbol
R1 RCM Inc. /DE [ RCM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X 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. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
Remarks:
On June 21, 2022, pursuant to the Transaction Agreement and Plan of Merger, dated as of January 9, 2022, by and among R1 RCM Holdco Inc. (f/k/a R1 RCM Inc.) ("Old R1"), R1 RCM Inc. (f/k/a Project Roadrunner Parent Inc.) (the "Company"), Project Roadrunner Merger Sub Inc. ("R1 Merger Sub"), CoyCo 1, L.P. and CoyCo 2, L.P., R1 Merger Sub was merged with and into Old R1, with Old R1 surviving as a direct, wholly owned subsidiary of the Company (the "Reorganization"). As a result, each share of Old R1's common stock issued and outstanding immediately prior to the Reorganization was automatically exchanged into an equivalent corresponding share of common stock of the Company and Old R1's stockholders became stockholders of the Company. This report reflects the beneficial ownership of the reporting person immediately prior to the consummation of the Reorganization and does not include the securities of the Company acquired by the reporting person upon the consummation of the Reorganization. The reporting person will file a Form 4 reporting the acquisition of Company securities in connection with the consummation of the Reorganization. Exhibit 24 - Power of Attorney attached hereto.
No securities are beneficially owned.
/s/ E. Terry Platis, Attorney-in-Fact 06/23/2022
** Signature of Reporting Person Date
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 5 (b)(v).
** 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 is insufficient, see Instruction 6 for procedure.
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