-----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, ALqwCnFDK4iTGZv8NGxnyMIR5lD2rYYNTA55ZieAoZPOPCphKPv2sg6b6eKG8pZG zKYobS93clIp333URW9DfA== 0001209191-05-021202.txt : 20050419 0001209191-05-021202.hdr.sgml : 20050419 20050419163714 ACCESSION NUMBER: 0001209191-05-021202 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050415 FILED AS OF DATE: 20050419 DATE AS OF CHANGE: 20050419 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PROVINCE HEALTHCARE CO CENTRAL INDEX KEY: 0001044942 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-GENERAL MEDICAL & SURGICAL HOSPITALS, NEC [8062] IRS NUMBER: 621710772 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 105 WESTPARK DR STREET 2: STE 400 CITY: BRENTWOOD STATE: TN ZIP: 37027 BUSINESS PHONE: 6153701377 MAIL ADDRESS: STREET 1: 105 WESTPARK DR STREET 2: SUITE 180 CITY: BRENTWOOD STATE: TN ZIP: 37207 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SLIPKOVICH DANIEL S CENTRAL INDEX KEY: 0001189151 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 333-34421 FILM NUMBER: 05759637 BUSINESS ADDRESS: BUSINESS PHONE: 6153728500 MAIL ADDRESS: STREET 1: 103 POWELL COURT SUITE 200 CITY: BRENTWOOD STATE: TN ZIP: 37027 4 1 bna94295_bna03slipkovich.xml MAIN DOCUMENT DESCRIPTION X0202 4 2005-04-15 1 0001044942 PROVINCE HEALTHCARE CO PRV 0001189151 SLIPKOVICH DANIEL S 103 POWELL COURT SUITE 200 BRENTWOOD TN 37027 0 1 0 0 President and COO Stock Option 17.62 2005-04-15 4 D 0 250000 6.74 D 2014-02-02 Common Stock 250000 0 D Stock Option 15.75 2005-04-15 4 D 0 80000 8.61 D 2014-03-10 Common Stock 80000 0 D This option was canceled in the merger in exchange for a cash payment equal to the product of (i) the number of shares of the issuer's common stock subject to the award; and (ii) the excess, if any, of the per share merger consideration over the exercise price per share of the award. /s/ Daniel S. Slipkovich 2005-04-18 -----END PRIVACY-ENHANCED MESSAGE-----