-----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, C+1r/3mgB0/rs77d/9lqjq6v3nrwQ500vP4GV9fb4HZStbF3IS8j6U8AdvIUjClK YDkjrsDzOlYEQ7zUHG5+pA== 0001209191-04-051490.txt : 20041105 0001209191-04-051490.hdr.sgml : 20041105 20041105165703 ACCESSION NUMBER: 0001209191-04-051490 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041103 FILED AS OF DATE: 20041105 DATE AS OF CHANGE: 20041105 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-22217 FILM NUMBER: 041123407 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 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2004-11-03 0 0000895930 AMSURG CORP AMSG 0001203381 OVERHOLT BERGEIN F 801 WEISGARBER RD. STE. 100 KNOXVILLE TN 37950 1 0 0 0 Common stock 2004-11-03 4 M 0 2499 2.22 A 58093 D Common stock 2004-11-03 4 M 0 2499 3.12 A 60592 D Common stock 2004-11-03 4 M 0 2499 3.94 A 63091 D Common stock 4500 I Grandchildren's trust Common stock 4506 I Gastrointestinal Associates, P.C., which Dr. Overholt is President Stock option 2.22 2004-11-03 4 M 0 2499 2.22 D 1995-12-16 2004-12-16 Common stock 2499 0 D Stock option 3.12 2004-11-03 4 M 0 2499 3.12 D 1997-02-01 2006-02-01 Common stock 2499 0 D Stock option 3.94 2004-11-03 4 M 0 2499 3.94 D 1998-02-07 2007-02-07 Common stock 2499 0 D /s/ Bergein F. Overholt, M.D. 2004-11-05 -----END PRIVACY-ENHANCED MESSAGE-----