0001209191-12-006454.txt : 20120131 0001209191-12-006454.hdr.sgml : 20120131 20120131182453 ACCESSION NUMBER: 0001209191-12-006454 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111231 FILED AS OF DATE: 20120131 DATE AS OF CHANGE: 20120131 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Eastridge Kevin Delon CENTRAL INDEX KEY: 0001441036 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-22217 FILM NUMBER: 12560496 MAIL ADDRESS: STREET 1: AMSURG STREET 2: 20 BURTON HILLS BOULEVARD CITY: NASHVILLE STATE: TN ZIP: 37215 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: SUITE 500 CITY: NASHVILLE STATE: TN ZIP: 37215 BUSINESS PHONE: 615-665-1283 MAIL ADDRESS: STREET 1: 20 BURTON HILLS BLVD. STREET 2: SUITE 500 CITY: NASHVILLE STATE: TN ZIP: 37215 5 1 doc5.xml FORM 5 SUBMISSION X0304 5 2011-12-31 0 0 0 0000895930 AMSURG CORP AMSG 0001441036 Eastridge Kevin Delon 20 BURTON HILLS BLVD. SUITE 500 NASHVILLE TN 37215 0 1 0 0 Sr. VP of Finance, CAO Common stock 36024 D Employee stock option 24.10 2004-01-28 2014-01-28 Common stock 15000 15000 D Employee stock option 25.76 2005-01-27 2015-01-27 Common stock 25000 25000 D Employee stock option 21.07 2006-02-17 2016-02-17 Common stock 20000 20000 D Employee stock option 22.84 2011-02-15 2017-02-15 Common stock 7377 7377 D Employee stock option 24.75 2012-02-21 2018-02-21 Common stock 7819 7819 D Options are to purchase shares of common stock and vest in equal installments over 4 years, starting on the Date Exercisable. Options are to purchase shares of common stock and vest 4 years from transaction date. /s/ Kevin D. Eastridge 2012-01-31