Amended Statement of Changes in Beneficial Ownership (4/a)
November 26 2019 - 5:08PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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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1. Name and Address of Reporting Person
*
CHAFEY DAVID H JR |
2. Issuer Name and Ticker or Trading Symbol
TRIPLE-S MANAGEMENT CORP
[
GTS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
P.O. BOX 363628 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/12/2019 |
(Street)
SAN JUAN, PR 00936-3628
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
11/14/2019 |
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Class B Common Stock | 11/12/2019 | | P | | 5375 | A | $18.47 (1) | 23228 (2) | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Explanation of Responses: |
(1) | The price reported in Column 4 is a weighted average price. The shares were purchased in multiple transactions at prices ranging from $18.45 to $18.48, inclusive. The reporting person undertakes to provide to Triple-S Management Corporation ("TSM"), any security holder of TSM, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the range set forth in this footnote to this Form 4. |
(2) | On November 14, 2019, the reporting person filed a Form 4 reporting that he owned 22,361 shares of Class B Common Stock, when in fact he owned the number of shares specified in this Form. The amount of securities beneficially owned reported in Column 5 includes 867 Class B Common Stock shares received by the reporting person pursuant to a share dividend issued by TSM to all Class B Common Stock shareholders on August 6, 2019. The increase in the number of shares owned by a reporting person as a result of a share dividend is exempt from Section 16 of the Securities Exchange Act of 1934, as amended (the "Act"), under Rule 16a-9 of the Act. As a result, such shares were not required to be reported and were not reported on a Form 4 at the time of the share dividend. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
CHAFEY DAVID H JR P.O. BOX 363628 SAN JUAN, PR 00936-3628 | X |
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Signatures
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/s/ Manual Rodriguez-Boissen, Attorney-in-fact | | 11/26/2019 |
**Signature of Reporting Person | Date |
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