Document:

EX-10.52

		
			EXHIBIT 10.52
		

		
			Initial Usage Date:  1/2/15
		

		
			NON-QUALIFIED STOCK OPTION AGREEMENT TERMS – OFFICER
		

		
			UNDER THE PERCEPTRON, INC. 2004 STOCK INCENTIVE PLAN
		

		
			THESE STOCK OPTION AGREEMENT TERMS pertain to stock options granted effective _____________ under the 2004 Stock Incentive Plan (the “Plan”) as detailed in the accompanying Notice of Grant of Stock Options and Option Agreement (the “Notice”) between Perceptron, Inc., a Michigan corporation ("the Corporation"), and the employee named in the Notice who is currently employed by the Corporation or one of its subsidiaries (the "Optionee").  A copy of the 2004 Stock Incentive Plan is not attached hereto but is available upon written request made to the Secretary of the Corporation.
		

		
			 
		

		
			1.Grant of Option.  Subject to the terms and conditions hereof, the Corporation hereby grants to the Optionee an option to purchase from the Corporation up to, but not exceeding in the aggregate, the number of shares of the Corporation’s Common Stock detailed in the accompanying Notice at the price per share designated in the Notice.  This option is not intended to constitute an "incentive stock option" within the meaning of Section 422 of the Internal Revenue Code ("Code").
		

		
			2.Right to Exercise Option.  Unless otherwise indicated in the Notice, the Optionee may purchase from the Corporation on and after the first anniversary of the date of grant, 33 1/3% of the shares covered by this option, and on each succeeding one year anniversary thereof may exercise an additional 33 1/3% of the shares covered by the option, so that on the third anniversary of the date of grant this option shall be fully exercisable. To the extent not exercised, installments shall accumulate and the Optionee may exercise them in whole or in part in any subsequent period.  Unless a shorter period is specified in the Notice under the “Expiration” column, and notwithstanding any provision of this Agreement, no portion of this option shall be exercisable on or after the tenth anniversary of the date of grant.  The Committee (as defined in the Plan), in its sole discretion, may accelerate the time at which this option may be exercised in whole or in part.
		

		
			3.Termination of Employment.  If, prior to the date that this option shall first become exercisable, the Optionee's employment with the Corporation or any of its subsidiaries shall be terminated for any reason, the Optionee's right to exercise this option shall terminate and all rights hereunder shall cease.  As used in this Agreement, the term "subsidiary" of the Corporation means any "subsidiary corporation" as defined in Section 424(f) of the Code, the term "employment" means employment with the Corporation or any subsidiary of the Corporation, and the term "disability" means "total and permanent disability," as defined in Section 22(e) of the Code.
		

		
			If, on or after the date that this option shall first become exercisable, the Optionee's employment shall be terminated for any reason other than death or disability, the Optionee shall have the right to exercise this option to the extent that it shall have been exercisable and unexercised on the date of such termination of services, at any time on or before the earlier of: (i) the expiration date of the option, or (ii) three (3) months after the date of such termination of employment, subject to any other limitation on the exercise of such option in effect at the date of exercise.
		

		
			 
		

		
			If on or after the date that this option shall first become exercisable the Optionee's employment shall be terminated due to death or disability, the Optionee or the executor or administrator of the estate of the Optionee (as the case may be) or the person or persons to whom the option shall have been transferred by will or by the laws of descent and distribution, shall have the right to exercise this option, at any time on or before the earlier of: (i) the expiration date of the option, or (ii) one (1) year from the date of the Optionee's death or disability, to the extent that it was exercisable and unexercised on the date of the Optionee’s death or disability, subject to any other limitation on exercise in effect at the date of exercise.
		

		

		

		 

 

		The transfer of the Optionee from one corporation to another among the Corporation and any of its subsidiaries, or a leave of absence with the written consent of the Corporation, shall not be a termination of services for purposes of this option.
		

		
			 
		

		
			4.Change in Control.  Notwithstanding the provisions of Section 2 "Right to Exercise Option" and Section 3 "Termination of Employment" of this Agreement, in the event of a Change in Control, any portion of this option that is then not exercisable shall become immediately exercisable.  For purposes hereof, a "Change in Control" shall be deemed to have occurred in the event of (i) a merger involving the Corporation in which the Corporation is not the surviving corporation (other than a merger with a wholly-owned subsidiary of the Corporation formed for the purpose of changing the Corporation's corporate domicile); (ii) a share exchange in which the shareholders of the Corporation exchange their stock in the Corporation for stock of another corporation (other than a share exchange in which all or substantially all of the holders of the voting stock of the Corporation, immediately prior to the transaction, exchange, on a pro rata basis, their voting stock of the Corporation for more than 50% of the voting stock of such other corporation); (iii) the sale of all or substantially all of the assets of the Corporation; or (iv) any person or group of persons (as defined by Section 13(d) of the Securities Exchange Act of 1934, as amended) (other than any employee benefit plan or employee benefit trust benefiting the employees of the Corporation) becoming a beneficial owner, directly or indirectly, of securities of the Corporation representing more than fifty (50%) percent of either the then outstanding Common Stock of the Corporation, or the combined voting power of the Corporation's then outstanding voting securities.
		

		
			In the event of a Change of Control, the Committee may, in its sole discretion and without the consent of the Optionee, cancel this option in exchange for a payment with respect to each vested share of Common Stock as provided in Section 9.2(b) of the Plan.
		

		
			 
		

		
			5. Exercise of Option.
		

			
	
			
				 (a)
			

			
	
			
			At any time that this option may be exercised as provided in this Agreement, the Optionee may exercise any portion of this option which is then exercisable, in whole or in part, by delivery to the Corporation of a written notice, in the form attached hereto, signed by the Optionee.

			
	
			
				 (b)
			

			
	
			
			In addition, the Optionee shall deliver, on the date of exercise:

		
			(i)cash equal to the purchase price of the shares being purchased,
		

		
			(ii)such documents as are or may be required under the terms of Section 2.4(b) of the Plan to effect a cashless exercise, except to the extent that the Corporation determines that the Optionee is not permitted to use a cashless exercise under applicable law, or 
		

		
			(iii)Permitted Shares with a Fair Market Value (as defined in the Plan and determined as of the date of exercise of the option) and equal to the purchase price of the shares being purchased and in accordance with Section 2.4 of the Plan (the "Delivered Shares Method").
		

		
			(c)"Permitted Shares" are shares of Corporation Common Stock to be delivered to pay the exercise price of the option (the "Delivered Shares"):
		

		
			(i)which have been owned by the Optionee for at least six months prior to the date of delivery, or
		

		
			(ii)if they have not been owned by the Optionee for at least six months prior to the date of delivery, the Optionee then owns, and has owned for at least six months prior thereto, a number of shares of Corporation Common Stock at least equal in number to the Delivered Shares. 
		

		
			(d)Shares which have been counted during the prior six months as owned by the Optionee for purposes of determining whether the Optionee may exercise options to purchase Common Stock pursuant to the Delivered Shares Method:
		

		
			(i)may not be used as Delivered Shares, and
		

		

		

		 

		

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		(ii)may not be counted as owned by the Optionee for purposes of making calculations under the Delivered Shares Method.
		

		
			6.Compliance With Securities Laws.  Anything to the contrary herein notwithstanding, the Corporation's obligation to sell and deliver stock under this option is subject to such compliance with federal and state laws, rules and regulations applying to the authorization, issuance or sale of securities, and applicable stock exchange requirements, as the Corporation deems necessary or advisable.  
		

		
			7.Non-Assignability.    The option hereby granted shall not be transferable by the Optionee other than by will or the laws of descent and distribution, and the option may be exercised during the Optionee's lifetime only by the Optionee.  Any transferee of the option shall take the same subject to the terms and conditions of this Agreement.  No such transfer of the option shall be effective to bind the Corporation unless the Corporation shall have been furnished with written notice thereof and a copy of the will and/or such other evidence as the Corporation may deem necessary to establish the validity of the transfer and the acceptance by the transferee or transferees of the terms and conditions of this Agreement.  No assignment or transfer of this option, or of the rights represented thereby, whether voluntary or involuntary, by operation of law or otherwise, except a transfer by the Optionee by will or by the laws of descent and distribution, shall vest in the purported assignee or transferee any interest or right herein whatsoever.
		

		
			8.Disputes.  As a condition of the granting of the option granted hereby, the Optionee and the Optionee's successors and assigns agree that any dispute or disagreement which shall arise under or as a result of this Agreement shall be determined by the Committee in its sole discretion and judgment and that any such determination and any interpretation by the Committee of the terms of this Agreement shall be final and shall be binding and conclusive for all purposes. 
		

		
			9. Adjustments.  In the event of any stock dividend, subdivision or combination of shares, reclassification, or similar transaction affecting the shares covered by this option, determined by the Committee to be covered by this Section 9, a proposed dissolution or liquidation of the Corporation, a merger of the Corporation with or into another corporation where the Corporation is not the surviving corporation, but its stock is exchanged for stock of the parent Corporation of the other party to the merger, the sale of substantially all of the assets of the Corporation, the reorganization of the Corporation or other similar transaction determined by the Committee to be covered by this Section 9, a proposed spin-off or a transfer by the Corporation of a portion of its assets resulting in the employment of the Optionee by the spin-off entity or the entity acquiring assets of the Corporation,  the rights of the Optionee shall be as provided in Section 9.1 of the Plan and any adjustment therein provided shall be made in accordance with Section 9.1 of the Plan.  
		

		
			10.Rights as Shareholder.  The Optionee shall have no rights as a shareholder of the Corporation with respect to any of the shares covered by this option until the issuance of a stock certificate or certificates upon the exercise of the option in full or in part, and then only with respect to the shares represented by such certificate or certificates.  
		

		
			11.Notices.  Every notice relating to this Agreement shall be in writing and if given by mail shall be given by registered or certified mail with return receipt requested.  All notices to the Corporation shall be delivered to the Secretary of the Corporation at the Corporation's headquarters or addressed to the Secretary of the Corporation at the Corporation's headquarters.  All notices by the Corporation to the Optionee shall be delivered to the Optionee personally or addressed to the Optionee at the Optionee's last residence address as then contained in the records of the Corporation or such other address as the Optionee may designate.  Either party by notice to the other may designate a different address to which notices shall be addressed.  Any notice given by the Corporation to the Optionee at the Optionee's last designated address shall be effective to bind any other person who shall acquire rights hereunder.
		

		
			12."Optionee" to Include Certain Transferees.    Whenever the word "Optionee" is used in any provision of this Agreement under circumstances where the provision should logically apply to any other person or persons to whom the option, in accordance with the provisions of Section 6 hereof, may be transferred, the word "Optionee" shall be deemed to include such person or persons.
		

		
			13.Governing Law.  This Agreement has been made in and shall be construed in accordance with the laws of the State of Michigan, without regard to its choice of law rules.
		

		
			14.Provisions of Plan Controlling.    The provisions hereof are subject to the terms and provisions of the Plan, 
		

		 

		

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		copies of which are available for review upon request.  In the event of any conflict between the provisions of this option and the provisions of the Plan, the provisions of the Plan shall control, except to the extent that the provisions of this option limit or restrict the rights of the Optionee to a greater extent than set forth in the Plan.
		

		
			15.Counterparts.   This Agreement may be executed in counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument.
		

		
			16.Captions.  The captions to the sections and subsections contained in this Agreement are for reference only, do not form a substantive part of this Agreement and shall not restrict or enlarge substantive provisions of this Agreement.
		

		
			17.Parties in Interest.  This Agreement shall bind and shall inure to the benefit of the parties hereto, their respective permitted successors and assigns.
		

		
			18.Complete Agreement.  This Agreement shall constitute the entire agreement between the parties hereto and shall supersede all proposals, oral or written, and all other communications between the parties relating to the subject matter of this Agreement.
		

		
			19.Modifications.   The terms of this Agreement cannot be modified except in writing and signed by each of the parties hereto.
		

		
			20.Severability.  In the event that any one or more of the provisions of this Agreement should be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions contained herein shall not in any way be affected or impaired thereby.
		

		
			21.Withholding.  The Optionee hereby authorizes the Corporation to withhold from his compensation or agrees to tender the applicable amount to the Corporation to satisfy any requirements for withholding of income and employment taxes in connection with the exercise of the option granted hereby.
		

		
			 
		

		

		

		 

		

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		NOTICE OF EXERCISE OF NON-QUALIFIED STOCK OPTION
		

		
			UNDER THE PERCEPTRON, INC.
		

		
			2004 STOCK INCENTIVE PLAN
		

		
			 
		

		
			Perceptron, Inc.
		

		
			47827 Halyard Drive
		

		
			Plymouth, MI  48170
		

		
			 
		

		
			Dear Sir:
		

		
			 
		

		
			A non-qualified stock option was granted to me on      , to purchase       shares of Perceptron, Inc. Common Stock at a price of $      per share.    I hereby elect to exercise my non-qualified stock option with respect to       shares for an aggregate purchase price of $     .  I hereby elect to pay for such shares as follows:
		

		
			 
		

			
					
						Personal Check

					
					
						$

					
					
						 

				
	
					
						Cash

					
					
						$

					
					
						 

				
	
					
						Bank Draft

					
					
						$

					
					
						 

				
	
					
						Money Order

					
					
						$

					
					
						 

				
	
					
						Cashless Exercise

					
					
						$

					
					
						     

				
	
					
						Perceptron Common Stock

					
					
						$

					
					
						 

				
	
					
						Tax Withholding

					
					
						$

					
					
						     

				
	
					
						TOTAL

					
					
						$

					
0.00 
				

		
			 
		

		
			A personal check [or cash, bank draft or money order] for the purchase price is enclosed herewith.
		

		
			 
		

		
			Documents as are required to effect a cashless exercise are enclosed.
		

		
			 
		

		
			I hereby elect to exercise my stock option with respect to                        shares through a combination of cash payments and shares of Perceptron, Inc. Common Stock, as described on the attached Exhibit A.  A personal check for the purchase price to be paid in cash is enclosed herewith.  Certificates for shares of Perceptron, Inc. Common Stock are enclosed herewith, along with a duly executed stock power in proper form for transfer, with all signatures properly guaranteed by a national bank or member firm of the NYSE or AMEX.  I represent that the shares of Perceptron, Inc. Common Stock enclosed herewith have been owned by me for more than six months or I currently own more than shares of Perceptron, Inc. Common Stock which have been owned by me for more than six months.  Such shares have not been counted during the prior six months as owned by me for purposes of determining whether I may exercise options to purchase Common Stock pursuant to the Delivered Shares Method.  I represent that the shares of stock that I am purchasing upon this exercise of my option are being purchased for investment purposes and not with a view to resale.  This representation shall not be binding upon me if the shares of Common Stock that I am purchasing are subject to an effective Registration Statement under the Securities Act of 1933.
		

		
			 
		

		
			 
		

		
			 
		

			
					
						Optionee:

					
					
						 

					
					
						 

					
					
						Date:EX-10.1

 Exhibit 10.1 

AMSURG CORP. 

PERFORMANCE SHARE UNIT AWARD AGREEMENT 

THIS PERFORMANCE SHARE UNIT AWARD AGREEMENT (this “Agreement”) is made and entered into as of
February     , 2015 (the “Grant Date”), between AmSurg Corp., a Tennessee corporation, together with its subsidiaries (the “Company”), and NAME (the “Grantee”), under the
Company’s 2014 Equity and Incentive Plan (the “Plan”). Capitalized terms not otherwise defined herein shall have the meaning ascribed to such terms in the Plan. 

WHEREAS, the Company has adopted the Plan, which permits the issuance of Performance Awards denominated in Restricted Share Units
(“Performance Share Units”), each of which represents the right to receive one share of the Company’s common stock, no par value per share (a “Share”), upon certain terms and conditions as set forth herein; and 

WHEREAS, pursuant to the Plan, the Committee responsible for administering the Plan has granted an award of Performance Share Units to
the Grantee as provided herein. 
 NOW, THEREFORE, in consideration of the mutual covenants hereinafter set forth and for other good
and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto, intending to be legally bound hereby, agree as follows: 

1. Grant of Performance Share Units. 

(a) The Company hereby grants to the Grantee an award (the “Award”) of # Performance Share Units (the
“PSUs”, and such number of PSUs, the “Target Award”) on the terms and conditions set forth in this Agreement and as otherwise provided in the Plan. A bookkeeping account will be maintained by the Company to keep track of the PSUs
and any dividend equivalent units that may accrue as provided in Section 5. 
 (b) The Grantee’s rights with respect to the
Award shall remain forfeitable at all times prior to the date on which the restrictions shall lapse in accordance with Section 2 hereof. 

2. Restricted Period. 

(a) Definition. Except as provided herein and subject to such other exceptions as may be determined by the Committee in its discretion,
the “Restricted Period” for the Award means the period that begins on the Grant Date and expires with respect to one-third of the PSUs on each of the date the Committee certifies that the performance targets over the Performance Period (as
defined in Exhibit A), the second anniversary of the date hereof and third anniversary of the date hereof (each such date, a “Vesting Date”), but only if (i) and to the extent the Company has achieved the performance targets over the
Performance Period as certified by the Committee, and (ii) the Grantee has remained in service with the Company 

 
continuously until the applicable Vesting Date. The number of PSUs that become eligible to vest may be greater than or less than the Target Award, as more specifically set forth on Exhibit
A. The number of PSUs that are eligible to vest as a result of the actual achievement of the performance targets are hereinafter referred to as the “Eligible PSUs”. The portion of the PSUs that do not vest, if any, as a result of the
Company’s performance shall be cancelled upon the Committee’s certification of the actual performance against the applicable performance targets and the Grantee shall have no further rights thereto. 

(b) Termination of Employment. Except as provided in Section 2(c), Section 2(d), Section 2(e) or as
otherwise provided by the Committee, if the Grantee’s service as an employee of the Company terminates for any reason during the Restricted Period applicable to any PSUs, the Grantee shall forfeit all rights with respect to all such PSUs with
respect to which the applicable Restricted Period has not ended as of such date, and all rights of the Grantee to such PSUs and any dividend equivalents accrued thereon shall terminate, without further obligation on the part of the Company. 

(c) Death or Disability. Notwithstanding Section 2(b), (i) the Restricted Period shall end with respect to the Target
Award and such PSUs shall immediately vest upon the Grantee’s death or Disability on or prior to the end of the Performance Period, and (ii) the Restricted Period shall end with respect to the Eligible PSUs and such PSUs shall immediately
vest upon the Grantee’s death or Disability following the end of the Performance Period. For purposes of this Agreement, “Disability” shall have the same meaning as such term is defined under Section 409A of the Code. 

(d) Retirement. Notwithstanding Section 2(b), in the event of Grantee’s Retirement, the Restricted Period shall end
with respect to the Eligible PSUs and such Eligible PSUs shall immediately thereupon vest; provided, that if Grantee’s Retirement occurs prior to the end of the Performance Period, Grantee shall vest in the Eligible PSUs, and such PSUs shall
settle at the time the Committee certifies the actual performance of the Company as set forth in Exhibit A (or if earlier, upon a Change in Control as described in Section 2(e). 

(e) Change in Control. Upon the occurrence of a Change in Control: 

(i) In the event the entity surviving the Change in Control (the “Successor”) assumes the Award granted hereby, the number of PSUs
that shall be eligible to vest shall be (A) the Target Award, if the Change in Control occurs on or prior to the end of the Performance Period, or (B) the Eligible PSUs, if the Change in Control occurs after the end of the Performance
Period. The Restricted Period for any PSUs that are eligible to vest pursuant to (A) or (B) above shall end on the otherwise applicable Vesting Date; provided, that notwithstanding Section 2(a), in the event the Grantee’s
employment with the Successor is terminated without Cause by the Successor, or terminates for Good Reason by the Grantee or on account of Grantee’s death or Disability prior to such Vesting Date, the Restricted Period shall end with respect to
any PSUs with respect to which the Restricted Period had not yet ended and such PSUs shall immediately thereupon vest. 

 (ii) In the event the Successor does not assume the Award granted hereby or in the event the
Grantee is eligible for Normal Retirement as of the date of the Change in Control, the Restricted Period shall end with respect to a number of PSUs equal to (A) the Target Award, if the Change in Control occurs on or prior to the end of the
Performance Period, or (B) the Eligible PSUs, if the Change in Control occurs after the end of the Performance Period, and such PSUs shall vest as of the effective date of the Change in Control and the appropriate number of Shares shall be
released in accordance with Section 3. 
 For purposes of this Agreement, unless otherwise defined in any other contractual agreement between
Grantee and the Company, “Good Reason” means any of the following actions, without the Grantee’s express prior written approval: (A) there is a material diminution in the nature or the scope of the Grantee’s authority and
responsibilities; (B) there is a material diminution in the Grantee’s rate of base salary or overall compensation (for reasons other than Company performance or stock price); (C) the Company changes the principal location in which
Grantee is required to perform services outside a twenty (20) mile radius of such location without Grantee’s consent. “Good Reason” shall exist only if (A) Grantee notifies the Company of the existence of the condition that
otherwise constitutes Good Reason within ninety (90) days of the initial existence of the condition, (B) the Company fails to remedy the condition within forty-five (45) days following its receipt of Grantee’s notice of Good
Reason and (C) the Grantee separates from service from the Company due to the condition within twelve (12) months of the initial existence of such condition. For purposes of this definition, “Company” includes any Successor and
any Subsidiary or Affiliate of a Successor. 
 3. Settlement of PSUs upon Lapse of Restricted Period. The Grantee shall be entitled
to the settlement of the PSUs covered by this Agreement at the time that the Restricted Period applicable to such PSUs ends and such PSUs vest pursuant to Section 2(a), Section 2(c), Section 2(d) or
Section 2(e), as applicable (any such date, the “Settlement Date”). Such settlement shall be made as promptly as practicable thereafter (but in no event after the thirtieth day following the Settlement Date), through the
issuance to the Grantee (or to the executors or administrators of Grantee’s estate in the event of the Grantee’s death) of a stock certificate (or evidence such Shares have been registered in the name of the Grantee with the relevant stock
agent) for a number of Shares equal to the number of such vested PSUs and any Dividend Equivalent Units that may have accrued pursuant to Section 5 hereof; provided, that any cash-based dividend equivalent rights granted pursuant to
Section 5 hereof and any fractional Dividend Equivalent Units shall be paid in cash when (and only if) the PSUs to which they relate settle to the Grantee. The Grantee may receive, hold, sell or otherwise dispose of any such Shares
issued in settlement of the PSUs hereunder free and clear of any restrictions imposed under the Plan or this Agreement. 
 4. Withholding
Obligations. Except as otherwise provided by the Committee, upon the settlement of any PSUs subject to this Award, the Company shall reduce the number of Shares (and the amount of cash, in the case of cash-based dividend equivalent rights) that
would otherwise be issued to the Grantee upon settlement of the Award by a number of Shares 

 
having an aggregate Fair Market Value on the date of such issuance (or cash, if applicable) equal to the payment to satisfy the minimum withholding tax obligation of the Company with respect to
which the Award is being settled. 
 5. Dividend Rights. The Grantee shall receive dividend equivalent rights in respect of the PSUs
covered by this Award at the time of any payment of dividends to stockholders on Shares. At the Company’s option, the PSUs will be credited with either (a) additional Performance Share Units (the “Dividend Equivalent Units”)
(including fractional units) for cash dividends paid on Shares by (i) multiplying the cash dividend paid per Share by the number of PSUs (and previously credited Dividend Equivalent Units) outstanding and unpaid, and (ii) dividing the
product determined above by the Fair Market Value of a Share, in each case, on the date the dividend record date, or (b) a cash amount equal to the amount that would be payable to the Grantee as a stockholder in respect of a number of Shares
equal to the number of PSUs (and previously credited Dividend Equivalent Units) outstanding and unpaid as of the dividend record date; provided, that cash-based dividend equivalents shall be paid unless the Committee affirmatively elects to pay
Dividend Equivalent Units. The PSUs will be credited with Dividend Equivalent Units for stock dividends paid on shares of the Company’s Common Stock by multiplying the stock dividend paid per Share by the number of PSUs (and previously credited
Dividend Equivalent Units) outstanding and unpaid on the dividend record date. Each Dividend Equivalent Unit shall have a value equal to one Share. Each Dividend Equivalent Unit or cash dividend equivalent right will vest and be settled or payable
at the same time as the PSU to which the dividend equivalent right relates. For the avoidance of doubt, no dividend equivalent rights shall accrue under this Section 5 in the event that any dividend equivalent rights or other applicable
adjustments pursuant to Section 7 hereof provide similar benefits. 
 6. No Right to Continued Employment. This Agreement
shall not be construed as giving Grantee the right to be retained in the employ of the Company, and the Company may at any time dismiss Grantee from employment, free from any liability or any claim under the Plan. 

7. Adjustments. The Committee shall make equitable and proportionate adjustments in the terms and conditions of, and the criteria
included in, this Award in recognition of unusual or nonrecurring events (including, without limitation, the events described in Section 4.2 of the Plan) affecting the Company, or the financial statements of the Company, or of changes in
applicable laws, regulations, or accounting principles in accordance with the Plan. 
 8. Amendment to Award. Subject to the
restrictions contained in the Plan, the Committee may waive any conditions or rights under, amend any terms of, or alter, suspend, discontinue, cancel or terminate the Award, prospectively or retroactively; provided that any such waiver, amendment,
alteration, suspension, discontinuance, cancellation or termination that would materially and adversely affect the rights of the Grantee or any holder or beneficiary of the Award shall not to that extent be effective without the consent of the
Grantee, holder or beneficiary affected. 

 9. Plan Governs. The Grantee hereby acknowledges receipt of a copy of the Plan and agrees
to be bound by all the terms and provisions thereof. The terms of this Agreement are governed by the terms of the Plan, and in the case of any inconsistency between the terms of this Agreement and the terms of the Plan, the terms of the Plan shall
govern. 
 10. Recoupment Policy. Notwithstanding any provision of the Plan or this Agreement to the contrary, the Company may
require the Grantee to return Shares (or the value of such Shares when originally released to Grantee), cash dividend equivalents paid and any other amount required by law or by applicable Company policy to be returned, in the event that such
repayment is required in order to comply with the Company’s clawback or recoupment policy as then in effect or any laws or regulations relating to restatements of the Company’s publicly-reported financial results. 

11. Severability. If any provision of this Agreement is, or becomes, or is deemed to be invalid, illegal, or unenforceable in any
jurisdiction or as to any Person or the Award, or would disqualify the Plan or Award under any laws deemed applicable by the Committee, such provision shall be construed or deemed amended to conform to the applicable laws, or if it cannot be
construed or deemed amended without, in the determination of the Committee, materially altering the intent of the Plan or the Award, such provision shall be stricken as to such jurisdiction, Person or Award, and the remainder of the Plan and Award
shall remain in full force and effect. 
 12. Notices. All notices required to be given under this Grant shall be deemed to be
received if delivered or mailed as provided for herein, to the parties at the following addresses, or to such other address as either party may provide in writing from time to time. 

 

							
	To the Company:		AMSURG
			1A Burton Hills Boulevard
			Nashville, Tennessee 37215
			Attn: Director of Human Resources
		
	To the Grantee:		The address then maintained with respect to the Grantee in the Company’s records.

 13. Governing Law. The validity, construction and effect of this Agreement shall be determined in
accordance with the laws of the State of Tennessee without giving effect to conflicts of laws principles. 
 14. Successors in
Interest. This Agreement shall inure to the benefit of and be binding upon any successor to the Company. This Agreement shall inure to the benefit of the Grantee’s legal representatives. All obligations imposed upon the Grantee and all
rights granted to the Company under this Agreement shall be binding upon the Grantee’s heirs, executors, administrators and successors. 

 15. Resolution of Disputes. Any dispute or disagreement which may arise under, or as a
result of, or in any way related to, the interpretation, construction or application of this Agreement shall be determined by the Committee. Any determination made hereunder shall be final, binding and conclusive on the Grantee and the Company for
all purposes. 
 16. Section 409A. Notwithstanding anything herein to the contrary, to the maximum extent permitted by
applicable law, the settlement of the PSUs to be made to the Grantee pursuant to this Agreement is intended to qualify as a “short-term deferral” pursuant to Section 1.409A-1(b)(4) of the Regulations and this Agreement shall be
interpreted consistently therewith. However, in any circumstances where the settlement of the PSUs may not so qualify, the Committee shall administer the grant and settlement of such PSUs in strict compliance with Section 409A of the Code.
Further, notwithstanding anything herein to the contrary, to the extent that this Award constitutes deferred compensation for purposes of Section 409A of the Code (i) no PSU payable upon the Grantee’s termination of service shall be
issued, unless Grantee’s termination of service constitutes a “separation from service” within the meaning of Section 1.409A-1(h) of the Treasury Regulations and (ii) if at the time of a Grantee’s termination of
employment or service with the Company and all “service recipients” (as defined in the applicable provision of the Treasury Regulations), the Grantee is a “specified employee” as defined in Section 409A of the Code, and the
deferral of the commencement of any payments or benefits otherwise payable hereunder as a result of such termination of service is necessary in order to prevent the imposition of any accelerated or additional tax under Section 409A of the Code,
then the Company will defer the commencement of the payment of any such payments or benefits hereunder (without any reduction in such payments or benefits ultimately paid or provided to the Grantee) to the minimum extent necessary to satisfy
Section 409A of the Code until the date that is six months and one day following the Grantee’s termination of employment or service with the Company (or the earliest date as is permitted under Section 409A of the Code), if such
payment or benefit is payable upon a termination of employment or service. Each payment of PSUs constitutes a “separate payment” for purposes of Section 409A of the Code. Notwithstanding any other provision of this Agreement or the
Plan to the contrary, to the extent that this PSU Agreement constitutes deferred compensation for purposes of Section 409A of the Code, a “Change in Control” for purposes of this Agreement shall mean “change in the ownership of
the Company,” a “change in the effective control of the Company,” or a “change in the ownership of a substantial portion of the Company’s assets,” as such terms are defined in Section 1.409A-3(i)(5) of the Treasury
Regulations. 

 IN WITNESS WHEREOF, the parties have caused this Performance Share Unit Award Agreement to
be duly executed effective as of the day and year first above written. 
  

			
	AMSURG CORP.
		
	By:		
		
	Name:		
	Title:		

  

	
	GRANTEE:
	
	  

	Name

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