Curtis A Sampson Form 4 Canterbury Park Holding / CURTIS A SAMPSON ownership change

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^*

SAMPSON CURTIS A

(Last) (First) (Middle)

1100 CANTERBURY PARK RD

(Street)

SHAKOPEE MN 55379

(City) (State) (Zip)

2. Issuer Name and Ticker or Trading Symbol
Canterbury Park Holding Corp [ CPHC ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	X	10% Owner
	Officer (give title below)		Other (specify below)

3. Date of Earliest Transaction (Month/Day/Year)
10/04/2019

4. 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 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
Common Stock	10/04/2019		M		3,000	A	$7.05	261,000	I(1)	By Trust
Common Stock								202,621	D
Common Stock								344,000	I(2)	By Trust
Common Stock								11,300	I(3)	By Spouse
Common Stock								53,000	I(4)	By Trust

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
Non-Qualified Stock Option	$7.05	10/04/2019		M			3,000	08/01/2010	02/01/2020	Common Stock	3,000	(5)	3,000	D

Explanation of Responses:

1. The stock is owned by the Curtis A. Sampson Revocable Trust. The reporting person is a trustee of the Trust and disclaims any beneficial ownership of the stock, except to the extent of the reporting person's pecuniary interest in the shares [held by the trust].

2. The stock is owned by Marian Arlis Sampson 2012 Irrevocable Trust. The reporting person is a trustee of the Trust and disclaims any beneficial ownership of the stock, except to the extent of the reporting person's pecuniary interest in the shares [held by the trust].

3. The reporting person disclaims any beneficial interest in the shares owned by his spouse.

4. The stock is owned by the Curtis A. Sampson 2012 Family Irrevocable Trust. The reporting person is a trustee of the Trust and disclaims any beneficial ownership of the stock, except to the extent of the reporting person's pecuniary interest in the shares [held by the trust].

5. Not applicable to non-qualified stock option grant.

	Alex Scheinost by Power of Attorney for Curtis A. Sampson	10/07/2019
	** 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.
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