Filing Details

Accession Number:
0001209191-10-030795
Form Type:
4
Zero Holdings:
No
Publication Time:
2010-05-27 13:00:00
Reporting Period:
2010-05-25
Filing Date:
2010-05-27
Accepted Time:
2010-05-27 15:26:07
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1472595 Accretive Health Inc. AH Services-Management Services (8741) 020698101
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1232914 A Mary Tolan C/O Accretive Health, Inc.
401 North Michigan Avenue, Suite 2700
Chicago IL 60611
Founder, President And Ceo Yes Yes Yes No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2010-05-25 2,190,999 $0.00 10,694,415 No 4 C Direct
Common Stock Disposition 2010-05-25 719,026 $11.28 9,975,389 No 4 S Direct
Common Stock Acquisiton 2010-05-25 104,599 $12.00 10,079,988 No 4 J Direct
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 C Direct
No 4 S Direct
No 4 J Direct
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Series A Convertible Preferred Stock Disposition 2010-05-25 1,096 $0.00 1,316,851 $0.00
Common Stock Series D Convertible Preferred Stock Disposition 2010-05-25 222,997 $0.00 874,148 $0.00
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
0 No 4 C Direct
0 No 4 C Direct
Reported Non-Derivative Holdings
Sec. Name Remaning Holdings Nature of Ownership Explanation
Common Stock 2,587,200 Indirect By Tolan Family Trust
Common Stock 646,800 Indirect By Tolan Gamma Trust
Footnotes
  1. Reflects shares of Common Stock received in satisfaction of a liquidation preference payment required to be paid to the Reporting Person upon the closing of the Issuer's initial public offering.
  2. The shares are held in a trust, the beneficiaries of which are members of Ms. Tolan's immediate family. Members of Ms. Tolan's immediate family are trustees of the trust.
  3. The Series A Convertible Preferred Stock automatically converted into the Issuer's common stock immediately prior to the closing of the Issuer's initial public offering on a 1,201.5069 for one basis and had no expiration date.
  4. The Series D Convertible Preferred Stock automatically converted into the Issuer's common stock immediately prior to the closing of the Issuer's initial public offering on a 3.92 for one basis and had no expiration date.