-----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, Obt0Kd5jCKYHKVUYWcU6uOJ2uDYaOqL06sKLkGjKs1MFlPcyid2oYpokyUiITXOa vRCboWwlX9u24WXzaSzyXg== 0001188112-10-002959.txt : 20101102 0001188112-10-002959.hdr.sgml : 20101102 20101102180617 ACCESSION NUMBER: 0001188112-10-002959 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20101102 FILED AS OF DATE: 20101102 DATE AS OF CHANGE: 20101102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Arguedas Clare CENTRAL INDEX KEY: 0001501276 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-34930 FILM NUMBER: 101159413 MAIL ADDRESS: STREET 1: 3280 PEACHTREE ROAD STREET 2: SUITE 2625 CITY: ATLANTA STATE: GA ZIP: 30305 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ExamWorks Group, Inc. CENTRAL INDEX KEY: 0001498021 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HEALTH SERVICES [8000] IRS NUMBER: 272909425 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3280 PEACHTREE ROAD STREET 2: SUITE 2625 CITY: ATLANTA STATE: GA ZIP: 30305 BUSINESS PHONE: 404-952-2400 MAIL ADDRESS: STREET 1: 3280 PEACHTREE ROAD STREET 2: SUITE 2625 CITY: ATLANTA STATE: GA ZIP: 30305 4 1 edgar.xml PRIMARY DOCUMENT X0303 4 2010-11-02 0001498021 ExamWorks Group, Inc. EXAM 0001501276 Arguedas Clare 3280 PEACHTREE ROAD, N.E., SUITE 2625 ATLANTA GA 30305 0 1 0 0 VP, General Counsel, Ass.SCTRY Common Stock 2010-11-02 4 C 0 11310 A 11310 D Series A Convertible Preferred Stock 2010-11-02 4 C 0 11310 0 D Common Stock 11310 0 D Series A Convertible Preferred Stock 2010-05-07 4 P 0 11310 6.63 A Common Stock 11310 11310 D Employee Stock Option (right to buy) 11.67 2010-10-06 4 A 0 25705 0 A 2020-10-06 Common Stock 25705 25705 D Each share of Series A Convertible Preferred Stock automatically converted into one share of common stock simultaneously upon the completion of the Issuer's initial public offering and had no expiration date. The shares subject to the option vest in three equal annual installments beginning on October 1, 2011. /s/ J. Miguel Fernandez de Castro, Attorney-In-Fact 2010-11-02 -----END PRIVACY-ENHANCED MESSAGE-----