0000895930-16-000103.txt : 20160202
0000895930-16-000103.hdr.sgml : 20160202
20160202165218
ACCESSION NUMBER: 0000895930-16-000103
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20151231
FILED AS OF DATE: 20160202
DATE AS OF CHANGE: 20160202
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: 1A BURTON HILLS BLVD.
CITY: NASHVILLE
STATE: TN
ZIP: 37215
BUSINESS PHONE: 615-665-1283
MAIL ADDRESS:
STREET 1: 1A BURTON HILLS BLVD.
CITY: NASHVILLE
STATE: TN
ZIP: 37215
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: HERR HENRY D
CENTRAL INDEX KEY: 0000903096
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36531
FILM NUMBER: 161381573
MAIL ADDRESS:
STREET 1: ONE BURTON HILLS BLVD
CITY: NASHVILLE
STATE: TN
ZIP: 37215
5
1
wf-form5_145444992716084.xml
FORM 5
X0306
5
2015-12-31
0
0
0
0000895930
AMSURG CORP
AMSG
0000903096
HERR HENRY D
110 31ST AVE NORTH, UNIT 1003
NASHVILLE
TN
37203
1
0
0
0
Common stock
107710
D
5.250% Mandatory Convertible Preferred Stock, Series A-1
2017-07-01
Common stock
400.0
400
D
The Company's 5.250% mandatory convertible preferred stock, Series A-1 (the "Preferred Stock") will automatically convert on July 1, 2017. Holders of the Preferred Stock have the right to convert the Preferred Stock at any time prior to July 1, 2017 into shares of the Company's common stock. If the applicable market value of the Company's common stock is equal to or greater than $55.13, the fixed conversion rate will be 1.8141 shares of the Company's common stock per share of Preferred Stock, or a total of $725.64 shares of common stock. If the applicable market value of the Company's common stock is less than or equal to $45, the fixed conversion rate will be 2.2222 shares of the Company's common stock per share of Preferred Stock, or a total of 888.88 shares of common stock. If the applicable market value of the Company's common stock is more than $45.00 and less than $55.13, then the conversion rate will be equal to $100 divided by the applicable market value of the Company's stock.
/s/ Henry D. Herr
2016-02-02