Ownership Submission
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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. 20549ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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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OMB APPROVAL
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OMB Number:3235-0362Expires:January 31, 2005Estimated average burden hours per response...1.0
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1. Name and Address of Reporting Person *
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CARLSON LEROY T JR
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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)
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__X__ Director
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_____ 10% Owner
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_____ Officer (give title below)
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_____ Other (specify below)
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President and CEO /
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(Last)
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(First)
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(Middle)
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30 N. LASALLE ST., STE. 4000
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3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
2021-12-31
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(Street)
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CHICAGO
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IL
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60602
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4. If Amendment, Date Original Filed(Month/Day/Year)
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6. Individual or Join/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
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2. Transaction Date (Month/Day/Year)
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2A. Deemed Execution Date, if any (Month/Day/Year)
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3. Transaction Code
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4. Securities Acquired (A) or Disposed of (D)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
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6. Ownership Form: Direct (D) or Indirect (I)
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7. Nature of Indirect Beneficial Ownership
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
(e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date (Month/Day/Year)
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3A. Deemed Execution Date, if any (Month/Day/Year)
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4. Transaction Code
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
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8. Price of Derivative Security
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
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11. Nature of Indirect Beneficial Ownership
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(A)
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(D)
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Date Exercisable
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Expriation Date
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Title
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Amount or Number of Shares
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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 LEROY T JR
30 N. LASALLE ST., STE. 4000
CHICAGO, IL60602
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X
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President and CEO
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Signatures
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Julie D. Mathews, by power of atty
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2022-01-18
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**Signature of Reporting Person
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Date
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Explanation of Responses:
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(*)
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If the form is filed by more than one reporting person, see Instruction 5(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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(1)
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Includes 3768 Common Shares owned by children. Reporting person disclaims beneficial ownership of shares owned by children.
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(2)
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Includes 5242 Common Shares owned by children. Reporting person disclaims beneficial ownership of shares owned by children.
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(3)
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Voluntary report of shares held in trust, the trustee of which is a third party and beneficiaries include the spouse and descendants
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(4)
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Voluntary reporting of shares in TDS 401K. The information is based on a plan statement dated 12/31/21. The number of shares fluctuates and is attributable to the price of the shares on 12/31/21.
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(5)
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Reporting person is one of four trustees which is record owner of these shares which files its holdings on forms 4. The shares reported are held by respective reporting person and his family members that have a pecuniary interest in such securities. Includes 690,604 Common Shares held by a family partnership of which reporting person is a general partner.
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(6)
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On August 12, 201 the reporting person's spouse's GRAT transferred voting trust certificates representing 77,716 to the spouse individually. The reporting person previously reported all securities held by spouse and spouse's GRAT. Accordingly the transfer did not result in the change in the number of securities reported as beneficially owned by reporting person.
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(7)
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Granted under the 2011 Long Term Incentive Plan. Options vest over a 3 year period with one-third becoming exercisable on the first anniversary, one-third on the second anniversary and one-third becoming exercisable on the third anniversary.
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(8)
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Restricted stock unit award pursuant to the 2011 Long Term Incentive Plan. Stock units will become vested on third anniversary.
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(9)
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Series A Common shares are convertible, on a share-for-share basis, into common shares.
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(10)
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Reporting person is one of four trustees which is record owner of these shares which files its holdings on forms 4. The shares reported are held by respective reporting person and his family members that have a pecuniary interest in such securities. Includes 752,615 Series A Common Shares held by a family partnership of which reporting person is a general partner.
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(11)
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Reporting person deferred bonuses pursuant to the TDS Long Term Incentive Plans. Employer matches vest ratably at a rate of 33%, 33%, 34% over three years. A total of 70,384 common shares units were vested at 12/31/21.
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Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
See Instruction 6 for procedure.Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
