Amended Annual Statement of Changes in Beneficial Ownership (5/a)
11 Février 2013 - 2:10PM
Edgar (US Regulatory)
FORM 5
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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).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
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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
*
Carlson Prudence E
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2. Issuer Name
and
Ticker or Trading Symbol
TELEPHONE & DATA SYSTEMS INC /DE/ [TDS]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
30 N. LASALLE ST. STE. 4000
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2012
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(Street)
CHICAGO, IL 60602
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
1/16/2013
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
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7. Nature of Indirect Beneficial Ownership
(Instr. 4)
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Amount
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(A) or (D)
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Price
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Common Shares
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51891.37
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D
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Common Shares
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1720560.978
(1)
(3)
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I
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By Voting Trust
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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 Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Series A Common Shares
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(4)
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(4)
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Common Shares
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195253.7427
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195253.7427
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D
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Series A Common
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(4)
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(4)
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Common Shares
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1871520.457
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1871520.457
(2)
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I
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By Voting Trust
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Explanation of Responses:
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(
1)
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Reporting person is one of four trustees of a voting trust which is record owner of these common shares and which files its holdings on a Form 4. Beneficial ownership is disclaimed with respect to 34,654.729 common shares held for the benefit of spouse and children. Includes 24,011.34 in reporting person's name and 975,216 in reporting person's Grantor Retained Annuity Trust (GRAT) both held for the benefit of the reporting person and 686,678.909 held by family partnerships of which reporting person is a general partner.
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(
2)
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Reporting person is one of four trustees of a voting trust which is record owner of these Series A Common shares and which files its holdings on a Form 4. Beneficial ownership is disclaimed with respect to 31,498.721 Series A common shares held for the benefit of spouse and children. Includes 1,840,021.736 shares which are held by family partnerships of which reporting person is a general partner. On Nov 27, reporting person acquired 60,240 LP units of a family partnership and gifted 30,120 LP units to her spouse. On Nov 27, reporting person acquired 60,240 LP units of a family partnership and gifted 30,120 LP units to her spouse. On Dec 21 and 26, respectively, the reporting person and her spouse each gifted 30,120 LP units to a descendents trust, of which a third party is trustee. These transfers did not result in any change in the number of securities reported as beneficially owned by the reporting person. The reporting person disclaims beneficial ownership of all securities t
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(
3)
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On Oct 12, the reporting person transferred voting trust certificates representing 4553 common shares from reporting person's GRAT to reporting person individually. The reporting person previously reported all securities held in her name and through a GRAT. 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.
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(
4)
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Series A Common shares are convertible on a share for share basis into common.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Carlson Prudence E
30 N. LASALLE ST. STE. 4000
CHICAGO, IL 60602
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X
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Signatures
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Julie D. Mathews, by power of atty
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2/11/2013
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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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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Note:
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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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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 control number.
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