SEC Form 5
Washington, D.C. 20549


Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB Number: 3235-0362
Estimated average burden
hours per response: 1.0
Check this 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*
Dalton Travis

(Last) (First) (Middle)


(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
EVP & Chief Client & Serv. Off
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock 12/31/2021 J(1) 136 A $72.09(1)(2) 539 I by 401(k) Plan
Common Stock 12/31/2021 J(3) 327 A $62.13(2)(3) 759 I by ASPP account
Common Stock 06/08/2021 J(4) 305 D $0.00 454 I by ASPP account
Common Stock 06/08/2021 J(4) 305 A $0.00 19,188 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Non-Qualified Stock Option (right to buy) $65.27 05/01/2019 05/01/2027 Common Stock 5,000 5,000 D
Non-Qualified Stock Option (right to buy) $57.24 05/04/2020 05/04/2028 Common Stock 9,698 9,698 D
Non-Qualified Stock Option (right to buy) $65.88 04/29/2020 04/29/2029 Common Stock 6,441 6,441 D
Restricted Stock Units $0.00 04/30/2021 04/28/2023 Common Stock 4,804 4,804 D
Restricted Stock Units $0.00 02/12/2022 02/12/2023 Common Stock 3,336 3,336 D
Restricted Stock Units $0.00 04/28/2023 04/28/2023 Common Stock 7,255 7,255 D
Restricted Stock Units $0.00 05/07/2022 05/07/2024 Common Stock 21,954 21,954 D
Explanation of Responses:
1. Represents shares acquired through routine payroll deduction and participation in the issuer's 401(k) plan between 1/16/2021 and 12/31/2021, at prices ranging from $69.58 to $80.12 per share. Balance is based on plan statement as of 12/31/2021. This transaction qualifies as a non-discretionary transaction from a tax-qualified plan.
2. Full information regarding the number of shares acquired at each separate price will be provided upon request by the Commission staff, Cerner Corporation, or a Cerner shareholder.
3. Represents shares purchased through the associate stock purchase plan (ASPP), an Internal Revenue Code Section 423 stock purchase plan, in transactions exempt under Rule 16b-3(c), at prices ranging from $59.92 to $79.62.
4. Represents a transfer of shares between ASPP account and direct account.
/s/ Shane M. Dawson, by Power of Attorney 01/21/2022
** 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 4 (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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.