0000895930-16-000291.txt : 20161201 0000895930-16-000291.hdr.sgml : 20161201 20161201163613 ACCESSION NUMBER: 0000895930-16-000291 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161201 FILED AS OF DATE: 20161201 DATE AS OF CHANGE: 20161201 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMSURG CORP CENTRAL INDEX KEY: 0000895930 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-OFFICES & CLINICS OF DOCTORS OF MEDICINE [8011] IRS NUMBER: 621493316 STATE OF INCORPORATION: TN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1A BURTON HILLS BLVD. CITY: NASHVILLE STATE: TN ZIP: 37215 BUSINESS PHONE: 615-665-1283 MAIL ADDRESS: STREET 1: 1A BURTON HILLS BLVD. CITY: NASHVILLE STATE: TN ZIP: 37215 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: JACOBS JOEY A CENTRAL INDEX KEY: 0001243878 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36531 FILM NUMBER: 162028739 MAIL ADDRESS: STREET 1: 830 CRESCENT CENTER DRIVE STREET 2: SUITE 610 CITY: FRANKLIN STATE: TN ZIP: 37067 4 1 wf-form4_148062816063861.xml FORM 4 X0306 4 2016-12-01 1 0000895930 AMSURG CORP AMSG 0001243878 JACOBS JOEY A C/O AMSURG 1A BURTON HILLS BLVD NASHVILLE TN 37215 1 0 0 0 Common stock 2016-12-01 4 D 0 10331 D 0 D Disposition pursuant to the terms of the Agreement and Plan of Merger, dated as of June 15, 2016, by and among Envision Healthcare Holdings,Inc., New Amethyst Corp. and AmSurg Corp. (the "Merger Agreement"), exempt under Rule 16b-3. Pursuant to the terms of the Merger Agreement, at the Merger 1 Effective Time (as defined in the Merger Agreement), each share of common stock held by the reporting person immediately prior to the Merger 1 Effective Time was assumed by New Amethyst and converted into a New Amethyst share of common stock having the same terms and conditions, taking into account any changes thereto by reason of the Mergers (as defined in the Merger Agreement). /s/ Joey A. Jacobs 2016-12-01