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) 06/17/2011 | ||||||||||||||||||||||||||
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 | ||||||
Common Stock | 06/17/2011 | D | 12,672 | D | (1) | 9,506 | D | |||
Common Stock | 06/17/2011 | D | 9,506 | D | (2) | 0 | 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 | ||||||||
Stock Option (right to buy) | $18.75 | 06/17/2011 | D | 175,000 | (3) | 12/17/2013 | Common Stock | 175,000 | (3) | 0 | D | ||||
Stock Option (right to buy) | $14.355 | 06/17/2011 | D | 40,000 | (4) | 03/05/2015 | Common Stock | 40,000 | (4) | 0 | D | ||||
Stock Option (right to buy) | $10.825 | 06/17/2011 | D | 60,000 | (5) | 02/09/2016 | Common stock | 60,000 | (5) | 0 | D | ||||
Stock Option (right to buy) | $18.46 | 06/17/2011 | D | 15,977 | (6) | 02/11/2017 | Common Stock | 15,977 | (6) | 47,933 | D | ||||
Stock Option (right to buy) | $18.46 | 06/17/2011 | D | 47,933 | (7) | 02/11/2017 | Common Stock | 47,933 | (7) | 0 | D | ||||
Stock Option (right to buy) | $20.05 | 06/17/2011 | D | 59,350 | (8) | 02/10/2018 | Common Stock | 59,350 | (8) | 0 | D |
Explanation of Responses: |
1. Pursuant to the merger of a wholly-owned subsidiary of Endo Pharmaceutials Holdings Inc. ("Endo") with and into American Medical Systems Holdings, Inc. (the "Merger"), such shares were disposed of in exchange for $380,160 in cash. |
2. These restricted shares were assumed by Endo in the Merger in exchange for 7,181 restricted shares of Endo common stock, having a market value of $38.32 per share on the effective date of the Merger. The vesting terms of the new Endo restricted stock grants will remain the same as the vesting terms of the old grants. |
3. This option, which has vested, was canceled in the Merger in exchange for a cash payment of $1,968,750 representing the difference between the exercise price of the option and the $30.00 per share price. |
4. This option, which has vested, was canceled in the Merger in exchange for a cash payment of $625,800 representing the difference between the exercise price of the option and the $30.00 per share price. |
5. This option, which has vested, was canceled in the Merger in exchange for a cash payment of $1,150,500 representing the difference between the exercise price of the option and the $30.00 per share price. |
6. This option, which vested with respect to 25% of the shares on March 31, 2011 and with respect to the remaining shares, quarterly over the next three years, was canceled with respect to 15,977 shares in the Merger in exchange for a cash payment of $184,374.58 representing the difference between the exercise price of the option and the $30.00 per share price. |
7. This option, which vested with respect to 25% of the shares on March 31, 2011 and with respect to the remaining shares, quarterly over the next three years, was assumed by Endo in the Merger and replaced with an option to purchase 36,213 shares of Endo common stock with an exercise price of $24.44 per share. |
8. This option, which vested with respect to 25% of the shares on March 31, 2012 and with respect to the remaining shares, quarterly over the next three years, was assumed by Endo in the Merger and replaced with an option to purchase 44,838 shares of Endo common stock with an exercise price of $26.54 per share. |
/s/ Mark A. Heggestad | 06/21/2011 | |
** 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. |