|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | 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. | SEC 2270 (9-02) |
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 Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: 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 | |||||||||
Non-Qualified Stock Option | $ 11.82 | Â | Â | Â | Â | Â | 05/18/2010 | 05/18/2020 | Common Stock | Â | 3,000 | Â | ||
Non-Qualified Stock Option | $ 9.73 | Â | Â | Â | Â | Â | 05/21/2009 | 05/21/2019 | Common Stock | Â | 3,000 | Â | ||
Non-Qualified Stock Option | $ 11.41 | Â | Â | Â | Â | Â | 05/21/2008 | 05/21/2018 | Common Stock | Â | 3,000 | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SAMPSON CURTIS A PO BOX 777 S MAIN ST HECTOR, MN 55342 |
 X |  X |  |  |
/s/ Curtis A. Sampson | 01/26/2011 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Shares held in a 1989 irrevocable trust |
(2) | Shares held in the Communications Systems Inc. Employee Stock Ownership Plan (CSI ESOP). Mr. Sampson is a trustee of the CSI ESOP and disclaims beneficial ownership of any shares of the issuer held by the CSI ESOP in excess of the shares allocated to his individual CSI ESOP account, which total 41,355 shares. |
(3) | Shares held by Mr. Sampson's spouse. Mr. Sampson disclaims beneficial ownership of shares of the Issuer registered in the name of his spouse. |
 Remarks: This Form 5 presents, as of December 31, 2010, the Reporting Person's beneficial ownership of shares of the Issuer's common stock for purposes of Section 16 under the Securities Exchange Act of 1934, as amended. Mr. Sampson disclaims any beneficial ownership of the shares of the Issuer owned by the Sampson Family Foundation. Although Mr. Sampson is the president and manager of the Sampson Family Foundation and makes investment decisions regarding the Foundation's securities transactions, by virtue of the Foundation's status as a 501(c)(3) tax-exempt organization, the Reporting Person may not, and in fact, does not personally derive any profit from the Foundation's transactions in the Issuer's common stock. As a result, for purposes of Section 16(b), Mr. Sampson has never been and is not currently the beneficial owner of any securities held by the Sampson Family Foundation, including the Issuer's common stock, and the inadvertent reporting of transactions in the Issuer's securities by the Sampson Family Foundation on previous Form 4s filed by this Reporting Person should be disregarded. |