SEC Form 4
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*
RUIZ COMAS RAMON M

(Last) (First) (Middle)
PO BOX 363628

(Street)
SAN JUAN PR 00936-3628

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
TRIPLE-S MANAGEMENT CORP [ GTS ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President & CEO
3. Date of Earliest Transaction (Month/Day/Year)
02/14/2011
4. If Amendment, Date of Original Filed (Month/Day/Year)
02/16/2011
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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
Class B Common Stock 02/14/2011 M 6,500 A $14.5 84,086 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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) $14.5 02/14/2011 M 6,500 (1) 12/05/2014 Class B Common Stock 6,500 $0.00 459,017 D
Stock Option (right to buy)(2) $14.5 02/14/2011 D(3) 243,500 (1) 12/05/2014 Class B Common Stock 243,500 $0.19(4) 215,517 D
Explanation of Responses:
1. The options being exercised and cancelled were part of a grant of 465,517 options on December 6, 2007 that vested in three equal installments on each of the first three anniversaries of the grant date. As of December 6, 2010, all options were vested and exercisable.
2. Amendment to Form 4 filed on February 16, 2011 reporting the exercise of stock options and the cancellation for value of certain stock options. This amendment is being filed to indicate the transaction code applicable to the cancellation and specify the price per deriviative security.
3. Partial cancellation of vested options.
4. On February 14, 2011, 243,500 options were cancelled by agreement between Mr. Ruiz and the Issuer. Mr. Ruiz received $1,258,895 (which is the difference between the exercise price of each option and the price of the Issuer's Class B Common Stock at market close on February 14, 2011 multiplied by the amount of options cancelled) as consideration for the cancellation.
Remarks:
/s/ Manuel Rodriguez Boissen, attorney-in-fact 07/08/2011
** 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).
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