0001127602-24-005069.txt : 20240214 0001127602-24-005069.hdr.sgml : 20240214 20240214170935 ACCESSION NUMBER: 0001127602-24-005069 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231231 FILED AS OF DATE: 20240214 DATE AS OF CHANGE: 20240214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADAMS W ANDREW CENTRAL INDEX KEY: 0001012853 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] ORGANIZATION NAME: 08 Industrial Applications and Services STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-10822 FILM NUMBER: 24640413 MAIL ADDRESS: STREET 1: P.O. BOX 1398 CITY: MURFREESBORO STATE: TN ZIP: 37133-1398 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NATIONAL HEALTH INVESTORS INC CENTRAL INDEX KEY: 0000877860 STANDARD INDUSTRIAL CLASSIFICATION: REAL ESTATE INVESTMENT TRUSTS [6798] ORGANIZATION NAME: 05 Real Estate & Construction IRS NUMBER: 621470956 STATE OF INCORPORATION: MD FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 222 ROBERT ROSE DRIVE CITY: MURFREESBORO STATE: TN ZIP: 37129 BUSINESS PHONE: 6158909100 MAIL ADDRESS: STREET 1: 222 ROBERT ROSE DRIVE CITY: MURFREESBORO STATE: TN ZIP: 37129 5 1 form5.xml PRIMARY DOCUMENT X0508 5 2023-12-31 0 0 0000877860 NATIONAL HEALTH INVESTORS INC NHI 0001012853 ADAMS W ANDREW 222 ROBERT ROSE DRIVE MURFREESBORO TN 37129 1 0 Common Stock By Amk, L.p. 2023-01-26 5 G 0 35000 0 D 0 D Common Stock by W. Andrew Adams Exempt Trust 121035 D Common Stock - Revocable Living Trust 708469 I Trustee Common Stock By Adams Family Foundation II 177000 I Trustee Common Stock by JMA Grandchildren's Trust 12635 I Trustee Common Stock - held by Spouse 11707 I Common Stock held by Spouse Stock Option Grant 2-21-19 79.96 2019-02-21 2024-02-21 Common Stock 25000 25000 D Stock Options (Right to Buy) 2-21-2020 90.79 2020-02-21 2025-02-21 Common Stock 25000 25000 D Stock Options (Right to Buy) 2-25-2021 69.20 2021-02-25 2026-02-25 Common Stock 25000 25000 D Stock Option (Right to buy) 2022 53.41 2022-02-25 2027-02-25 Common Stock 25000 25000 D Stock Option (Right to Buy) 2023 54.73 2023-02-24 2028-02-24 Common Stock 10000 10000 D To reflect a change in form of beneficial ownership as a result of Common stock held by W. Andrew Adams as direct owner and shares held by Springland Ventures, LP, the W. Andrew Adams Non-exempt trust, and AMK, LP being transferred to W. Andrew Adams Exempt Trust in 2023. To reflect a change in form of beneficial ownership as a result of 708,469 shares transferred from AMK, LP to the W. Andrew Adams Revocable Living Trust in 2023. /s/W. Andrew Adams 2024-02-14