SEC Form 5
FORM 5 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL 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). | |||||||||||||||||
Form 3 Holdings Reported. | |||||||||||||||||
Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol TELEPHONE & DATA SYSTEMS INC /DE/ [ TDS ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year) 12/31/2016 | ||||||||||||||||||||||||||
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 at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
Amount | (A) or (D) | Price | |||||||||||||
Common Shares | 40,005 | D | |||||||||||||
Common Shares | 1,956,719(2)(5) | I | By Voting Trust |
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) | |||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Series A Common shares | (1) | (1) | (1) | Common Shares | 1,134 | 1,134 | D | |||||||
Series A Common Shares | (1) | (1) | (1) | Common Shares | 2,256,570 | 2,256,570(3)(4)(5) | I | By Voting Trust |
Explanation of Responses: |
1. Series A Common shares are convertible, on a share-for-share basis, into common shares. |
2. Reporting person is one of four trustees which is record owner of these shares and while files its holdings on forms 4. Of these shares, 126,350 are held for the benefit of children, 7,770 are held by wife, and 687,833 are held by family partnership of which reporting person is a general partner. Includes 26,720 shares that reporting person is trustee of trusts which his children beneficially own the shares in the trusts. Reporting person disclaims beneficial ownership of shares held for benefit of persons other than the reporting person. The remaining shares include 350,000 in GRAT's name and 758,046 in the individual reporting person's name. |
3. Reporting person is one of four trustees which is record owner of these shares and while files its holdings on forms 4. Of these shares, 145,859 are held for the benefit of children, 713,032 are held by a family limited partnership, and 749,344 are held by family partnership of which reporting person is a general partner. Includes 28,867 that reporting person is trustee of trusts which his children beneficially own the shares in the trusts. Reporting person disclaims beneficial ownership of the shares held for the benefit of persons other than the reporting person. The remaining shares include 350,000 owned by GRAT and 269,468 shares in the individuals reporting person's name. |
4. On 12/29/16, the reporting person's GRAT transferred voting trust certificates representing 87,439 Series A Common shares to reporting person individually. The reporting person previously reported all securities held in his name and through GRATs. Accordingly, the transfer of voting trust certificates did not result in any change in the number of securities reported as beneficially owned by the reporting person. |
5. On 12/30/16, the reporting person transferred 350,000 Series A Common shares and 350,000 Common shares from his name individually into a GRAT. The reporting person previously reported all securities held in his name and through GRATs. Accordingly, the transfer of voting trust certificates did not result in any change in the number of securities reported as beneficially owned by the reporting person. |
Remarks: |
Julie D. Mathews, by power of atty | 01/09/2017 | |
** 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. |