SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Rivard Brent Robert

(Last) (First) (Middle)
12400 HIGH BLUFF DRIVE

(Street)
SAN DIEGO CA 92130

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/11/2004
3. Issuer Name and Ticker or Trading Symbol
AMN HEALTHCARE SERVICES INC [ AHS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Accounting Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 0 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options (Right to buy) 05/08/2004(1) 05/08/2013 Common Stock 10,000 9.68 D
Stock Options (Right to buy) 05/18/2005(2) 05/18/2014 Common Stock 12,000 14.94 D
Stock Options (Right to buy) 01/17/2003(3) 01/17/2012 Common Stock 12,000 22.98 D
Explanation of Responses:
1. The options to purchase shares of Common Stock were granted pursuant to AMN Healthcare Services, Inc. Stock Option Plan on May 8, 2003 and vest in four equal installments. Of these options, options to purchase 2,500 shares of Common Stock are currently vested (exercisable), and 2,500 of the unvested options for the right to purchase Common Stock vest on each of May 8, 2005, 2006 and 2007.
2. The options to purchase shares of Common Stock were granted pursuant to AMN Healthcare Services, Inc. Stock Option Plan on May 18, 2004 and vest in four equal installments on each of May 18, 2005, 2006, 2007 and 2008.
3. The options to purchase shares of Common Stock were granted pursuant to AMN Healthcare Services, Inc. Stock Option Plan and vest in four equal installments. On these options,options to purchase 6,000 shares of Common Stock are currently vested (exercisable), and 3,000 of the unvested options for the right to purchase Common Stock vest on January 17, 2005 and 3,000 shares vest on January 17, 2006
Brent Rivard 08/13/2004
** 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 5 (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.
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