X0303 4 2011-04-28 0 0001114200 AMERICAN MEDICAL SYSTEMS HOLDINGS INC AMMD 0001222351 GRAF A JAY C/O AMERICAN MEDICAL SYSTEMS 10700 BREN ROAD WEST MINNETONKA MN 55343 1 0 0 0 Common Stock 2011-04-28 4 A 0 5240 0 A 7360 D These shares were issued pursuant to a restricted stock grant under the American Medical Systems Holdings, Inc. 2005 Stock Incentive Plan (as Amended and Restated), such shares will vest with respect one third of the shares on each of 4/15/2012, 4/15/2013 and 4/15/2014 and are subject to forfeiture until vested. These shares were issued pursuant to restricted stock grants under the American Medical Systems Holdings, Inc. 2005 Stock Incentive Plan (as Amended and Restated), such shares are subject to forfeiture until vested. /s/ Mark Heggestad, attorney-in-fact 2011-05-02