-----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, MhTRmnuBnY6AEV1MTQZD35oxjQT+2scTXuia+GfQe20lw4y/nFyyhT1nEkchrmPH s+6dIgaBmuNmhvveObIWUg== 0001209191-04-009572.txt : 20040213 0001209191-04-009572.hdr.sgml : 20040213 20040213114652 ACCESSION NUMBER: 0001209191-04-009572 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031231 FILED AS OF DATE: 20040213 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: 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: OVERHOLT BERGEIN F CENTRAL INDEX KEY: 0001203381 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-22217 FILM NUMBER: 04596029 BUSINESS ADDRESS: STREET 1: C/O AMSURG CORP STREET 2: 20 BURTON HILLS BLVD STE 500 CITY: NASHVILLE STATE: TN ZIP: 37215 BUSINESS PHONE: 6156651283 MAIL ADDRESS: STREET 1: C/O AMSURG CORP STREET 2: 20 BURTON HILLS BLVD STE 500 CITY: NASHVILLE STATE: TN ZIP: 37215 5 1 doc5.xml FORM 5 SUBMISSION X0201 5 2003-12-31 0 0 0 0000895930 AMSURG CORP AMSG 0001203381 OVERHOLT BERGEIN F 801 WEISGARBER RD. STE. 100 KNOXVILLE TN 37950 1 0 0 0 Common stock 2003-11-20 5 G 0 192.0000 40.0000 D 35921.0000 D Common stock 2003-11-24 5 G 0 863.0000 38.3700 D 35058.0000 D Common stock 3000.0000 I Gandchildren's Trusts Common stock 3004.0000 I Gastrointestinal Associates, P.C., which Dr. Overholt is President Option 3.0900 1995-03-04 2004-03-04 Common stock 1666.0000 1666.0000 D Option 3.3300 1995-12-16 2004-12-16 Common stock 1666.0000 1666.0000 D Option 4.6800 1997-02-01 2006-02-01 Common stock 1666.0000 1666.0000 D Option 5.9100 1998-02-07 2007-02-07 Common stock 1666.0000 1666.0000 D Fully vested options to purchase shares of common stock /s/ Bergein F. Overholt, M.D. 2004-02-13 -----END PRIVACY-ENHANCED MESSAGE-----