Annual Statement of Changes in Beneficial Ownership (5)
February 03 2017 - 1:23PM
Edgar (US Regulatory)
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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
*
IRIZARRY MICHAEL
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2. Issuer Name
and
Ticker or Trading Symbol
UNITED STATES CELLULAR CORP [USM]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
EVP & CTO-Engineering and IS
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(Last)
(First)
(Middle)
8410 W. BRYN MAWR AVENUE
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2016
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(Street)
CHICAGO, IL 60631
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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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16298
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D
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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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Option (Right to Buy)
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$63.33
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(1)
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4/2/2017
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Common Shares
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33606
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33606
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D
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Option (Right to Buy)
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$49.05
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(1)
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4/1/2018
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Common Shares
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51474
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51474
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D
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Option (Right to Buy)
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$44.59
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(1)
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4/1/2021
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Common Shares
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43079
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43079
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D
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Option (Right to Buy)
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$41.22
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(2)
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4/1/2024
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Common Shares
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59300
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59300
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D
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Option (Right to Buy)
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$36.42
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(2)
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4/1/2025
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Common Shares
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70400
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70400
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D
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Option (Right to Buy)
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$45.87
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(2)
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4/1/2026
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Common Shares
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56050
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56050
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D
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Restricted Stock Units
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(3)
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4/1/2017
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Common Shares
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11310
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11310
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D
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Restricted Stock Units
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(3)
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4/1/2018
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Common Shares
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17950
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17950
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D
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Restricted Stock Units
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(3)
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4/1/2019
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Common Shares
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20006
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20006
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D
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Explanation of Responses:
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(
1)
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Granted under the long term incentive plan
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(
2)
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Options are scheduled to become exercisable in annual increments of one third on April 1 of each year
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(
3)
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Restricted stock units that become vested on third annual anniversary.
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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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IRIZARRY MICHAEL
8410 W. BRYN MAWR AVENUE
CHICAGO, IL 60631
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EVP & CTO-Engineering and IS
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Signatures
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Julie D. Mathews, by power of atty
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2/3/2017
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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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