SEC FORM
3
SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
222 MERCHANDISE MART PLAZA, SUITE 2024 |
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(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 12/01/2004
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3. Issuer Name and Ticker or Trading Symbol
ALLSCRIPTS HEALTHCARE SOLUTIONS INC
[ MDRX ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
President, Physicians Interact |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Common Stock |
15,600 |
D |
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Stock Option |
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07/26/2014 |
Common Stock |
75,000 |
7.73 |
D |
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Stock Option |
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07/26/2014 |
Common Stock |
100,000 |
7.73 |
D |
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Explanation of Responses: |
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Gina Nienberg for Mark Thierer by Power of Attorney |
04/26/2006 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* If the form is filed by more than one reporting person,
see
Instruction
5
(b)(v). |
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
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EXHIBIT 24
LIMITED POWER OF ATTORNEY
The undersigned hereby appoints William Davis, Kathie Kittner, Gina
Nienberg and Greg Swanson as his/her attorney-in-fact to act for
him/her and in his/her name solely to do all or any of the following:
1. To execute and file with the Securities and Exchange
Commission all statements regarding his/her beneficial ownership
of securities of Allscripts Healthcare Solutions, Inc. filed pursuant
to Section 16(a) of the Securities Exchange Act of 1934;
2. To execute all necessary instruments to carry out and perform
any of the powers stated above, and to do any other acts requisite to
carrying out such powers.
Neither the above mentioned nor any attorney-in-fact substituted
under this power shall incur any liability to the undersigned for
acting or refraining from acting under this power, except for such
attorneys own willful misconduct or gross negligence.
Any reproduced copy of this signed original shall be deemed to be
an original counterpart of this Power of Attorney.
This Power of Attorney is governed by Illinois law.
This Power of Attorney shall terminate upon receipt by any of the
above mentioned from the undersigned of a written notice of revocation
of this Power of Attorney. The undersigned shall have the right to
revoke this Power of Attorney at any time.
IN WITNESS WHEREOF, the undersigned has executed this Power of
Attorney this 8th day of June, 2005.
By: _____/s/ Mark Thierer_____
Mark Thierer