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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
[ ] Check 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
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1. Name and Address of Reporting Person*
Murphy, Jr., Thomas S.
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(Last) (First) (Middle)
c/o Goldman, Sachs & Co.
85 Broad Street
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(Street)
New York, NY 10004
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Quorum Health Group, Inc.
(QHGI)
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3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary)
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4. Statement for Month/Year
FYE June 30, 2000
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[ X ] Director [ ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
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7. Individual or Joint/Group Reporting
(Check applicable line)
[ X ] Form Filed by One Reporting Person
[ ] Form Filed by More than One Reporting Person
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<TABLE>
<CAPTION>
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Table I -- Non-Derivative Securities Acquired, Disposed of, |
or Beneficially Owned |
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| | | | | | |
| | | |5. |6. | |
| | |4. |Amount of |Owner- | |
| | |Securities Acquired (A) or |Securities |ship | |
| | |Disposed of (D) |Beneficially |Form: |7. |
| | |(Instr. 3, 4 and 5) |Owned at end |Direct |Nature of |
|2. | 3. |-------------------------------|of Issuer's |(D) or |Indirect |
1. |Transaction |Transaction | | (A) | |Fiscal Year |Indirect |Beneficial|
Title of Security |Date |Code | Amount | or | Price |(Instr. 3 |(I) |Ownership |
(Instr. 3) |(mm/dd/yy) |(Instr. 8) | | (D) | |and 4) |(Instr.4)|(Instr. 4)|
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
| | | | | | | | |
| | | | | | | | |
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</TABLE>
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).
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FORM 5 (continued)
<TABLE>
<CAPTION>
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Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned |
(e.g., puts, calls, warrants, options, convertible securities) |
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| | | | | | | | | | |
| | | | | | | |9. |10. | |
| | | | | | | |Number |Owner-| |
| | | | | | | |of |ship | |
|2. | | | | | | |Deriv- |of | |
|Conver-| | |5. | |7. | |ative |Deriv-|11. |
|sion | | |Number of | |Title and Amount | |Secur- |ative |Nature|
|or | | |Derivative |6. |of Underlying |8. |ities |Secur-|of |
|Exer- | | |Securities |Date |Securities |Price |Bene- |ity: |In- |
|cise |3. | |Acquired (A) |Exercisable and |(Instr. 3 and 4) |of |ficially |Direct|direct|
|Price |Trans- |4. |or Disposed |Expiration Date |--------------------|Deriv- |Owned |(D) or|Bene- |
1. |of |action |Trans-|of (D) |(Month/Day/Year) | |Amount |ative |at End |In- |ficial|
Title of |Deriv- |Date |action|(Instr. 3, |---------------------| |or |Secur- |of |direct|Owner-|
Derivative |ative |(Month/ |Code |4 and 5) |Date |Expira- | |Number |ity |Year |(I) |ship |
Security |Secur- |Day/ |(Instr|---------------|Exer- |tion | |of |(Instr.|(Instr. |(Instr|(Instr|
(Instr. 3) |ity |Year) |8) | (A) |(D) |cisable |Date |Title |Shares |5) |4) |4) |4) |
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Stock Option | | | | | | | | | | | | | |
(right to buy)|$12.56 | 07/01/99 | A | 5,001 | | 01 | 07/01/04 |Common Stock| 5,001 | | 5,001 | D | |
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Stock Option | | | | | | | | | | | | | |
(right to buy)|$17.50 | | | | | 01 | 07/01/01 |Common Stock| 5,001 | | 5,001 | D(02)| |
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Stock Option | | | | | | | | | | | | | |
(right to buy)|$24.00 | | | | | 01 | 07/01/02 |Common Stock| 5,001 | | 5,001 | D | |
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Stock Option | | | | | | | | | | | | | |
(right to buy)|$27.13 | | | | | 01 | 07/01/03 |Common Stock| 5,001 | | 5,001 | D | |
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</TABLE>
Explanation of Responses:
01: These options were granted to the Reporting Person under the Quorum Health
Group, Inc. Directors Stock Option Plan, qualified under Rule 16b-3. The options
were granted on 7/1/99, 7/1/96, 7/1/97 and 7/1/98, respectively; they each
become exercisable in four equal annual installments commencing one year after
the respective date of grant.
02: The Reporting Person is a managing director of Goldman, Sachs & Co.
("Goldman Sachs"). Goldman Sachs is an indirect wholly-owned subsidiary of The
Goldman Sachs Group, Inc. ("GS Group"). The Reporting Person has an agreement
with GS Group pursuant to which he holds these stock options for the benefit of
GS Group. The Reporting Person does not have any pecuniary interest in the stock
options and accordingly, disclaims beneficial ownership thereof.
By: s/ Roger S. Begelman November 8, 2000
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**Signature of Reporting Person Date
Attorney-in-fact
** 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 provided is insufficient, see Instruction 6 for procedure.
Alternatively, this Form is permitted to be submitted to the Commission in
electronic format at the option of the Reporting Person pursuant to Rule
101(b)(4) of Regulation S-T.
