FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
AMERICAN MEDICAL SYSTEMS HOLDINGS INC [ AMMD ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 02/24/2005 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Voting Common Stock | 02/24/2005 | M | 20,000 | A | $8.85 | 28,079.389(2)(3) | D | |||
Voting Common Stock | 02/24/2005 | S | 20,000 | D | $40 | 8,079.389(2)(3) | D | |||
Voting Common Stock | 02/25/2005 | M | 11,000 | A | $8.85 | 19,079.389(2)(3) | D | |||
Voting Common Stock | 02/25/2005 | S | 11,000 | D | $39.7594 | 8,079.389(2)(3) | D | |||
Voting Common Stock | 02/25/2005 | M | 47,500 | A | $8.3333 | 55,579.389(2)(3) | D | |||
Voting Common Stock | 02/25/2005 | S | 9,000 | D | $39.7594 | 46,579.389(2)(3) | D | |||
Voting Common Stock | 02/25/2005 | S | 5,000 | D | $39.7505 | 41,579.389(2)(3) | D | |||
Voting Common Stock | 02/25/2005 | S | 10,000 | D | $39.798 | 31,579.389(2)(3) | D | |||
Voting Common Stock | 02/25/2005 | S | 5,000 | D | $39.7702 | 26,579.389(2)(3) | D | |||
Voting Common Stock | 02/25/2005 | S | 10,000 | D | $39.712 | 16,579.389(2)(3) | D | |||
Voting Common Stock | 02/25/2005 | S | 8,500 | D | $39.7041 | 8,079.389(2)(3) | D | |||
Voting Common Stock | 02/28/2005 | M | 54,500 | A | $8.3333 | 62,579.389(2)(3) | D | |||
Voting Common Stock | 02/28/2005 | S | 2,500 | D | $39.8077 | 60,079.389(2)(3) | D | |||
Voting Common Stock | 02/28/2005 | S | 2,500 | D | $39.7778 | 57,579.389(2)(3) | D | |||
Voting Common Stock | 02/28/2005 | S | 2,500 | D | $39.75 | 55,079.389(2)(3) | D | |||
Voting Common Stock | 02/28/2005 | S | 7,500 | D | $39.3 | 47,579.389(2)(3) | D | |||
Voting Common Stock | 02/28/2005 | M | 48,000 | A | $8.3333 | 95,579.389(2)(3) | D | |||
Voting Common Stock | 02/28/2005 | M | 40,000 | A | $15.99 | 135,579.389(2)(3) | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Employee Stock Option (right to buy) | $8.85 | 02/24/2005 | M | 20,000 | (1) | 04/19/2011 | Voting Common Stock | 20,000 | $8.85 | 11,000 | D | ||||
Employee Stock Option (right to buy) | $8.85 | 02/25/2005 | M | 11,000 | (1) | 04/19/2011 | Voting Common Stock | 11,000 | $8.85 | 0 | D | ||||
Employee Stock Option (right to buy) | $8.3333 | 02/25/2005 | M | 47,500 | (1) | 06/29/2010 | Voting Common Stock | 47,500 | $8.3333 | 54,500 | D | ||||
Employee Stock Option (right to buy) | $8.3333 | 02/28/2005 | M | 15,000 | (1) | 06/29/2010 | Voting Common Stock | 15,000 | $8.3333 | 39,500 | D | ||||
Employee Stock Option (right to buy) | $8.3333 | 02/28/2005 | M | 39,500 | (1) | 06/29/2010 | Voting Common Stock | 39,500 | $8.3333 | 0 | D | ||||
Employee Stock Option (right to buy) | $8.3333 | 02/28/2005 | M | 48,000 | (1) | 06/29/2010 | Voting Common Stock | 48,000 | $8.3333 | 0 | D | ||||
Employee Stock Option (right to buy) | $15.99 | 02/28/2005 | M | 40,000 | (1) | 02/06/2013 | Voting Common Stock | 40,000 | $15.99 | 36,663 | D |
Explanation of Responses: |
1. Fully Vested. |
2. Includes 6,079.389 share purchased under the Issuer's Employee Stock Purchase Plan. |
3. Includes 127,500 shares of common stock that Mr. Emerson has agreed to transfer to his spouse pursuant to a Marital Termination Agreement, dated February 24, 2005. Mr. Emerson has also agreed to transfer to his spouse unvested options to purchase an aggregate of 69,989 shares of common stock pursuant to the Marital Termination Agreement. The Marital Termination Agreement is subject to court approval, and Mr. Emerson anticipates completing the transfer to his spouse of the foregoing shares of common stock and options to purchase common stock upon court approval of the Marital Termination Agreement. |
Martin J. Emerson | 02/28/2005 | |
** 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 4 (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. |