-----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, NYWcPEWRucL8Xi+Xav14nhD4fow6V37uLe9WKehuSDXCmcxe5CDFAANI74iylQJN dcPnojWVT9YWiX/MifmkzQ== 0000950144-05-005879.txt : 20050524 0000950144-05-005879.hdr.sgml : 20050524 20050524170022 ACCESSION NUMBER: 0000950144-05-005879 CONFORMED SUBMISSION TYPE: 8-K PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20050518 ITEM INFORMATION: Entry into a Material Definitive Agreement ITEM INFORMATION: Financial Statements and Exhibits FILED AS OF DATE: 20050524 DATE AS OF CHANGE: 20050524 FILER: 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 FILING VALUES: FORM TYPE: 8-K SEC ACT: 1934 Act SEC FILE NUMBER: 000-22217 FILM NUMBER: 05854807 BUSINESS ADDRESS: STREET 1: 20 BURTON HILLS BLVD STREET 2: STE 350 CITY: NASHVILLE STATE: TN ZIP: 37215 BUSINESS PHONE: 6156651283 MAIL ADDRESS: STREET 1: ONE BURTON HILLS BLVD. STREET 2: SUITE 350 CITY: NASHVILLE STATE: TN ZIP: 37215 8-K 1 g95525e8vk.htm AMSURG CORP. - FORM 8-K AMSURG CORP. - FORM 8-K
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 8-K

CURRENT REPORT

Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934

Date of Report (Date of earliest event reported): May 24, 2005 (May 18, 2005)

AMSURG CORP.

(Exact Name of Registrant as Specified in Charter)
         
Tennessee   000-22217   62-1493316
(State or Other Jurisdiction of   (Commission   (I.R.S. Employer
Incorporation)   File Number)   Identification No.)
     
20 Burton Hills Boulevard    
Nashville, Tennessee   37215
(Address of Principal Executive Offices)   (Zip Code)

(615) 665-1283
(Registrant’s Telephone Number, Including Area Code)

Not Applicable
(Former Name or Former Address, if Changed Since Last Report)

     Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions (see General Instruction A.2. below):

     o Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)

     o Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)

     o Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))

     o Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))

 


TABLE OF CONTENTS

Item 1.01. Entry Into a Material Definitive Agreement
Item 9.01. Financial Statements and Exhibits
SIGNATURES
EX-10.1 FORM OF RESTRICTED STOCK AGREEMENT


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Item 1.01. Entry Into a Material Definitive Agreement

     On May 18, 2005, the Compensation Committee (the “Committee”) of the Board of Directors of AmSurg Corp. (the “Company”) approved contribution amounts for the Company’s Supplemental Executive Retirement Savings Plan and approved a new Long Term Care Plan. Pursuant to the Company’s Supplemental Executive Retirement Savings Plan, employees who are at the executive level of Vice President or higher may make pre-tax contributions to an investment account established in such executive’s name by deferring a portion of their base compensation and their bonus compensation. The Company makes additional contributions in its discretion based on a formula set by the Committee. For 2005, the Committee has approved a contribution equal to 3% of the annual base compensation of such executives, plus an additional contribution ranging from 2% to 15% of the annual base compensation of such executives, depending on the level of corporate profits achieved. The Company’s contributions vest in equal increments over five years, subject to automatic vesting if the executive retires, dies, or becomes disabled, if the plan terminates or if there is a change in control of the Company.

     The Committee also approved a Long Term Care Plan for the Company. Pursuant to the terms of the Long Term Care Plan, covered employees are entitled to receive monthly payments in the event they become disabled and require long term care. The Company will pay the premium for a $2,000 per month benefit for employees at the executive level of Vice President or higher, and those employees may purchase additional coverage up to a maximum benefit of $6,000 per month at their expense. Employees of the Company below the level of Vice President may purchase coverage under the plan up to a maximum benefit of $6,000 per month at their expense.

     On the date of each annual meeting of shareholders, each non-employee director who is elected or reelected to the Board of Directors of the Company, or who otherwise continues as a director, automatically receives on the date of the annual meeting of shareholders a grant of that number of shares of restricted common stock of the Company having an aggregate fair market value on such date equal to $10,000, adjusted annually for changes in the Consumer Price Index, or CPI. On May 19, 2005, the date of the Company’s 2005 annual meeting of shareholders, each non-employee director received 432 shares of common stock having an aggregate fair market value of $11,910. The form of Restricted Stock Award Agreement is attached hereto as Exhibit 10.1.

Item 9.01. Financial Statements and Exhibits

         (c)  Exhibit 10.1 — Form of Restricted Stock Agreement

2


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SIGNATURES

     Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.
         
  AMSURG CORP.
 
 
  By:   /s/ Claire M. Gulmi    
    Claire M. Gulmi
 
 
    Senior Vice President, Chief Financial
Officer and Secretary
(Principal Financial and Duly Authorized Officer) 
 
 

Date: May 24, 2005

3


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INDEX TO EXHIBITS

           
Exhibit      
Number
  Description
   
10.1
  Form of Restricted Stock Agreement  

 

EX-10.1 2 g95525exv10w1.txt EX-10.1 FORM OF RESTRICTED STOCK AGREEMENT EXHIBIT 10.1 AMSURG CORP. 1997 STOCK INCENTIVE PLAN RESTRICTED STOCK AWARD AGREEMENT ____________ GRANT This RESTRICTED STOCK AWARD AGREEMENT (the "Agreement"), dated this ____ day of ______________, is by and between AmSurg Corp., a Tennessee corporation (the "Company"), and ____________________ (the "Grantee"), under the Company's 1997 Stock Incentive Plan, as amended (the "Plan"). Section 1. Restricted Stock Award. The Grantee is hereby granted the right to receive ____ shares of restricted stock (the "Restricted Stock") of the Company's Common Stock, no par value (the "Stock"), which number was determined by dividing (a) $__________ by (b) $_____ which was the closing bid price for the Stock on ___________, subject to the terms and conditions of this Agreement. Section 2. Vesting of the Award. Except as otherwise provided in Sections 3 or 4 below, the Restricted Stock will vest at such times (the "Vesting Date") and in the percentages and increments set forth below, as long as the Grantee is serving as a Director of the Company on the Vesting Date.
Award Percentage Award of of Restricted Restricted Vesting Date Stock Stock - ------------------------------- ---------------- ----------- _______________ 33 1/3% ____ shares Date of ____ Annual Shareholder 33 1/3% ____ shares Meeting Date of ____ Annual Shareholder 33 1/3% ____ shares Meeting
Section 3. Forfeiture on Termination as a Director. If the Grantee ceases to serve as a Director of the Company for any reason, all shares of Restricted Stock that have not vested prior to the date of termination of such Grantee's directorship will be forfeited and the Grantee shall have no further rights with respect to such shares of Restricted Stock. Section 4. Distribution of the Shares. From the date of grant of the Restricted Stock, the Grantee shall have the right to vote all shares of Restricted Stock held in the Grantee's name. Prior to the Vesting Date any and all dividends declared and paid in respect of the shares of Restricted Stock shall be held by the Company until the Vesting Date and shall thereafter be paid to the Grantee to the extent such shares have vested. Any dividends declared and paid in respect of forfeited shares shall revert to the Company on the Vesting Date. As of the Vesting Date, the Company shall deliver to the Grantee (or his or her personal representative or estate) the shares of Restricted Stock that have vested on or prior to such date (the "Distributed Shares"). Such Distributed Shares shall be represented by a certificate. Section 5. Restrictions on Transfer. 5.1 General Restrictions. The shares of Restricted Stock granted hereunder shall not be transferable by the Grantee (or his personal representative or estate) other than by will or by the laws of descent and distribution until the earlier of (a) five years from the date of grant, and (b) the date on which the Grantee ceases to serve as a director of the Company for any reason. The terms of this Agreement shall be binding on the executors, administrators, heirs and successors of the Grantee. 5.2 Change in Control. All restrictions imposed on the Restricted Stock shall expire automatically upon a Change of Control, as such term is defined in the Plan. Section 6. Investment Intent. As a condition to the receipt of any Distributed Shares, the Grantee (or his legal representative or estate or any third party transferee), if the Company so requests, will execute an agreement in form satisfactory to the Company in which the Grantee or such other recipient of the shares represents that he is purchasing the shares for investment purposes, and not with a view to resale or distribution. Section 7. Adjustment. In the event of any merger, reorganization, consolidation, recapitalization, extraordinary cash dividend, stock dividend, stock split or other change in corporate structure affecting the Stock, the number of shares of Restricted Stock subject to this Agreement may be adjusted by the Company as may be determined by the Board of Directors in accordance with the Plan. Section 8. Tax Election. The Grantee may, but is not required to, elect to apply the tax rules of Section 83(b) of the Internal Revenue Code of 1986, as amended (the "Code"), to the issuance of the Restricted Stock. If the Grantee makes an affirmative election under Section 83(b) of the Code, the Grantee will notify the Company within 90 days after making such election. Section 9. Governing Provisions. This Agreement is made under and subject to the provisions of the Plan, and all of the provisions of the Plan are also provisions of this Agreement. If there is a difference or conflict between the provisions of this Agreement and the provisions of the Plan, the provisions of the Plan will govern. By signing this Agreement, the Grantee confirms that he has received a copy of the Plan. Section 10. Miscellaneous. 10.1 Entire Agreement. This Agreement and the Plan contain the entire understanding and agreement between the Company and the Grantee concerning the Restricted Stock granted hereby, and supersede any prior or contemporaneous negotiations and understandings. The Company and the Grantee have made no promises, agreements, conditions, or understandings relating to the Restricted Stock, either orally or in writing, that are not included in this Agreement or the Plan. 10.2 Directorship. By establishing the Plan, granting awards under the Plan, and entering into this Agreement, the Company does not give the Grantee any right to continue to be elected as a director of the Company or to be entitled to any remuneration or benefits not set forth in this Agreement or the Plan. None of the provisions of this Agreement or the Plan will interfere with or limit the right of the Company to nominate another individual as a director of the Company at any time. 10.3 Captions. The captions and section numbers appearing in this Agreement are inserted only as a matter of convenience. They do not define, limit, construe, or describe the scope or intent of the provisions of this Agreement. 10.4 Counterparts. This Agreement may be executed in counterparts, each of which when signed by the Company and the Grantee will be deemed an original and all of which together will be deemed the same Agreement. 10.5 Notice. Any notice or communication having to do with this Agreement must be given by personal delivery or by certified mail, return receipt requested, addressed, if to the Company, to the principal office of the Company and, if to the Grantee, to the Grantee's address set forth below or any address of which the Grantee subsequently notifies the Company. 10.6 Amendment. The Chairman of the Board or the Board of Directors of the Company may amend the terms of this Agreement, but no such amendment shall impair the rights of the Grantee hereunder without the Grantee's consent. 10.7 Governing Law. This Agreement shall be governed and construed exclusively in accordance with the law of the State of Tennessee applicable to agreements to be performed in the State of Tennessee to the extent it may apply. 10.8 Withholding. As provided in the Plan, the Company shall have the right to withhold or require the Grantee to pay to the Company any amounts required to be withheld by the Company for payment of any Federal, state or local taxes in respect of the Restricted Stock. IN WITNESS WHEREOF, the Company and the Grantee have executed this Agreement to be effective as of __________________. AMSURG CORP. By: ------------------------------- Title: ------------------------- ------------------------------- -------------------------------
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