-----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, QQ171xuGQvEO5LLf/UhAgiOfKQyNT0iDWFQujORGfPAts6cjSB9l2Y7SUufoUdAu RA9H5Eux112hS+L5i/iJqg== 0001299239-04-000007.txt : 20041020 0001299239-04-000007.hdr.sgml : 20041020 20041020145901 ACCESSION NUMBER: 0001299239-04-000007 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041018 FILED AS OF DATE: 20041020 DATE AS OF CHANGE: 20041020 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PSYCHIATRIC SOLUTIONS INC CENTRAL INDEX KEY: 0000829608 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-SPECIALTY OUTPATIENT FACILITIES, NEC [8093] IRS NUMBER: 232491707 STATE OF INCORPORATION: DE FISCAL YEAR END: 0430 BUSINESS ADDRESS: STREET 1: 113 SEABOARD LANE STREET 2: SUITE C-100 CITY: FRANKLIN STATE: TN ZIP: 37067 BUSINESS PHONE: 615-312-5700 MAIL ADDRESS: STREET 1: 113 SEABOARD LANE STREET 2: SUITE C-100 CITY: FRANKLIN STATE: TN ZIP: 37067 FORMER COMPANY: FORMER CONFORMED NAME: PMR CORP DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: ZARON CAPITAL INC DATE OF NAME CHANGE: 19891116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LAMONT ANN H CENTRAL INDEX KEY: 0001199270 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-20488 FILM NUMBER: 041087431 BUSINESS ADDRESS: STREET 1: ONE GORHAM ISLAND CITY: WESTPORT STATE: CT ZIP: 06880 BUSINESS PHONE: 2032268346 MAIL ADDRESS: STREET 1: ONE GORHAM ISLAND CITY: WESTPORT STATE: CT ZIP: 06880 4 1 edgar.xml PRIMARY DOCUMENT X0202 4 2004-10-18 0000829608 PSYCHIATRIC SOLUTIONS INC PSYS 0001199270 LAMONT ANN H C/O OAK INVESTMENT PARTNERS ONE GORHAM ISLAND WESTPORT CT 06880 1 0 0 0 Common Stock 2004-10-18 4 C 0 663710 A 663710 I See Note Common Stock 2004-10-18 4 J 0 663532 D 178 I See Note Common Stock 2004-10-18 4 C 0 30731 A 30731 I See Note Common Stock 2004-10-18 4 J 0 30722 D 9 I See Note Common Stock 13034 D Series A Preferred Stock 2004-10-18 4 C 0 541455 D Common Stock 663710 0 I See Note Series A Preferred Stock 2004-10-18 4 C 0 28727 D Common Stock 30731 0 I See Note Represents the number of shares of Common Stock issued upon the conversion of shares of Series A Preferred Stock as reported in Table II. The conversion price of the Series A Preferred Stock was approximately $5.50 per share. Represents shares directly owned by Oak Investment Partners X, Limited Partnership ("Oak X, L.P."). On October 18, 2004, Oak X, L.P. made an in-kind distribution, without any additional consideration, of 663,532 shares of Common Stock, upon the conversion of Series A Preferred Stock are reported in Table II, to the limited and general partners of Oak X, L.P. In turn, the general partner made an in-kind distribution of the shares it received to its members. Represents shares directly owned by Oak X Affiliates Fund, Limited Partnership ("Oak X Affiliates, L.P."). On October 18, 2004, Oak X Affiliates, L.P. made an in-kind distribution, without any additional consideration, of 30,722 shares of Common Stock, upon the conversion of Series A Preferred Stock are reported in Table II, to the limited and general partners of Oak X Affiliates, L.P. In turn, the general partner made an in-kind distribution of the shares it received to its members. Represents shares directly owned by Ann H. Lamont, a director of the Psychiatric Solutions Inc., and received as part of the distributions described in footnotes 3 and 5. This acquisition merely reflects a change in beneficial ownership from indirect to direct. Each share of Series A Preferred Stock is initially convertible into 1 share of Common Stock at a conversion price of $5.50 per share. The conversion price remains subject to adjustment pursuant to the terms of the Series A Preferred Stock. The Series A Preferred Stock is immediately convertible. The conversion feature continues indefinitely. As the transaction involves the conversion of a derivative security, no information is required to be included in Column 8 of Table II, in accordance with general instruction 4(c)(iii). Remarks Ann H. Lamont is a Director of Psychiatric Solutions, Inc. Ms. Lamont is a Managing Member of Oak Associates X, L.L.C., the General Partner of Oak X, L.P.; and a Managing Member of Oak X Affiliates, L.L.C., the General Partner of Oak X Affiliates, L.P. Each Reporting Person disclaims the existence of a "group" and disclaims beneficial ownership of any securities (except to the extent of such Reporting Person's pecuniary interest in such securities) other than any securities reported herein as being directly owned by such Reporting Person, and this report shall not be deemed an admission that such Reporting Person is the beneficial owner of any such securities for purposes of Section 16 or for any other purpose. Ann H. Lamont 2004-10-20 -----END PRIVACY-ENHANCED MESSAGE-----