SEC Form 5 · accession 0001209191-15-012743

AMSURG CORP · AMSG

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Dec 31, 2014

Accepted (ET)

Feb 12, 2015 · 4:27 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0000895930

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common stock	holding	—	—		—	108,839	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
5.250% Mandatory Convertible Preferred Stock, Series A-1^F1	—	Dec 1, 2014	P	400	A	—	Jul 1, 2017	Common stock	—	400	D

F1The 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.