-----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, GBtvmE7bjwVaFLgqHqvcEwj1bLaZz19qxU10b3luuwP9ISfFMSksImcKw4jijEAn mKg44HXy3WxTVJNtcwOM5Q== 0001040441-04-000191.txt : 20040903 0001040441-04-000191.hdr.sgml : 20040903 20040903165904 ACCESSION NUMBER: 0001040441-04-000191 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040901 FILED AS OF DATE: 20040903 DATE AS OF CHANGE: 20040903 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: MCLANE JAMES W CENTRAL INDEX KEY: 0001190351 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09550-2B FILM NUMBER: 041017351 BUSINESS ADDRESS: STREET 1: TOWERS AT WILLIAMS SQUARE STREET 2: 5215 NORTH O'CONNOR BLVD., STE 800 CITY: IRVING STATE: TX ZIP: 75039 BUSINESS PHONE: 972-443-5210 MAIL ADDRESS: STREET 1: TOWERS AT WILLIAMS SQUARE STREET 2: 5215 NORTH OCONNOR BLVD STE 800 CITY: IRVINE STATE: TX ZIP: 75039 4 1 edgardoc.xml PRIMARY DOCUMENT X0202 4 2004-09-01 0 0001040441 BEVERLY ENTERPRISES INC BEV 0001190351 MCLANE JAMES W ONE THOUSAND BEVERLY WAY FORT SMITH AR 72919 1 0 0 0 PHANTOM STOCK UNITS 2004-09-01 4 A 0 621.5704 A 2004-09-01 $.10 Par Value Common Stock 621.5704 20120.7623 D These units of phantom stock have been granted under the Non-Employee Director Deferred Compensation Plan and are credited to a deferred share unit account each month, to be paid to the director, or, in the case of his/her death prior to retirement from the Board, his/her beneficiary(ies), in stock (or, with the Board's approval, in cash) upon his/her retirement from the Board, death or disability. Each Deferred Share Unit has a value equal to one share of common stock of Beverly. By: MONA BRANNON For: JAMES W MCLANE 2004-09-03 -----END PRIVACY-ENHANCED MESSAGE-----