Sec Form 5 Filing - CARLSON WALTER CD @ TELEPHONE & DATA SYSTEMS INC /DE/ - 2021-12-31

Insider filing report for Changes in Beneficial Ownership
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FORM 5
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
CARLSON WALTER CD
2. Issuer Name and Ticker or Trading Symbol
TELEPHONE & DATA SYSTEMS INC /DE/ [ TDS]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
30 N. LASALLE STREET, SUITE 4000
3. Date of Earliest Transaction (MM/DD/YY)
12/31/2021
(Street)
CHICAGO, IL60602
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 Shares 67,932 D
Common Shares 12/09/2021 G( 1 ) V 772,286 D $ 0 1,985,858( 2 ) I By Voting 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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
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 Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: 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
Series A Common Shares ( 3 ) ( 3 ) ( 3 ) Common Shares 1,311 1,311 D
Series A Common Shares ( 3 ) 12/09/2021 G( 1 ) V 280,955 ( 3 ) ( 3 ) Common Shares 280,955 $ 0 2,308,302( 4 ) I By Voting Trust
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
CARLSON WALTER CD
30 N. LASALLE STREET, SUITE 4000
CHICAGO, IL60602
X
Signatures
Julie D. Mathews, by power of atty 01/14/2022
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Reporting person individually gifted to family limited partnership. Reporting person previously reported all shares held by family partnership. Accordingly the gift did not result in a change in the number of securities reported as beneficially owned by reporting person.
( 2 )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.
( 3 )Series A Common shares are convertible, on a share-for-share basis, into common shares.
( 4 )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 which 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.

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).

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