-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, VzR1f6daG3oNx1WX2vLd9SRHfhP0mZKfY7Wm0nP+DFIDCk/GwVX3amO90yJI1pAs pwqBsgyg1ZW4kMFgplxlrw== 0001040441-04-000139.txt : 20040804 0001040441-04-000139.hdr.sgml : 20040804 20040804150823 ACCESSION NUMBER: 0001040441-04-000139 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040520 FILED AS OF DATE: 20040804 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BEVERLY ENTERPRISES INC CENTRAL INDEX KEY: 0001040441 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SKILLED NURSING CARE FACILITIES [8051] IRS NUMBER: 621691861 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: ONE THOUSAND BEVERLY WAY CITY: FORT SMITH STATE: AR ZIP: 72919 BUSINESS PHONE: 5014526712 MAIL ADDRESS: STREET 1: ONE THOUSAND BEVERLY WAY CITY: FORT SMITH STATE: AR ZIP: 72919 FORMER COMPANY: FORMER CONFORMED NAME: NEW BEVERLY HOLDINGS INC DATE OF NAME CHANGE: 19970604 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SUSIENKA CINDY H CENTRAL INDEX KEY: 0001190374 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09550-2B FILM NUMBER: 04951404 BUSINESS ADDRESS: STREET 1: ONE THOUSAND BEVERLY WAY CITY: FORT SMITH STATE: AR ZIP: 72919 BUSINESS PHONE: 479-201-2000 MAIL ADDRESS: STREET 1: ONE THOUSAND BEVERLY WAY CITY: FORT SMITH STATE: AR ZIP: 72919 4 1 edgardoc.xml PRIMARY DOCUMENT X0202 4 2004-05-20 0 0001040441 BEVERLY ENTERPRISES INC BEV 0001190374 SUSIENKA CINDY H ONE THOUSAND BEVERLY WAY FORT SMITH AR 72919 0 1 0 0 EXECUTIVE VICE PRESIDENT $.10 Par Value Common Stock 2004-05-20 4 A 0 49358 0 A 115542 D Restricted Stock issued and cliff vests three years from the date of grant. By: MONA BRANNON For: CINDY H SUSIENKA 2004-08-04 -----END PRIVACY-ENHANCED MESSAGE-----