- Annual Statement of Changes in Beneficial Ownership (5)
15 Dicembre 2011 - 1:19AM
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
Expires:
January 31, 2014
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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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
SHAW STEVEN A
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2. Issuer Name
and
Ticker or Trading Symbol
VOLT INFORMATION SCIENCES, INC. [VISI]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
PRESIDENT/CEO
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(Last)
(First)
(Middle)
C/O VOLT INFORMATION SCIENCES, INC., 560 LEXINGTON AVENUE
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3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
10/30/2011
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(Street)
NEW YORK, NY 10022
(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 Stock, $0.10 par value
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1023449
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D
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Common Stock, $0.10 par value
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131.168
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I
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By ESOP
(1)
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Common Stock, $0.10 par value
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16306.546
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I
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By 401(K)
(2)
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Common Stock, $0.10 par value
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147250
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I
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As Co-Trustee
(3)
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Common Stock, $0.10 par value
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331649
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I
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As Co-Trustee
(4)
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Common Stock, $0.10 par value
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2/5/2011
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G
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36516
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A
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$
0
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36516
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I
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As Co-Trustee
(5)
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Common Stock, $0.10 par value
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4/19/2011
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G
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30488
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A
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$
0
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67004
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I
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As Co-Trustee
(5)
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Common Stock, $0.10 par value
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4/21/2011
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G
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113658
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A
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$
0
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180662
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I
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As Co-Trustee
(5)
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Common Stock, $0.10 par value
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2/15/2011
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G
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73032
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A
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$
0
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73032
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I
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As Co-Trustee
(6)
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Common Stock, $0.10 par value
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4/19/2011
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G
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60977
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A
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$
0
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134009
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I
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As Co-Trustee
(6)
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Common Stock, $0.10 par value
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4/21/2011
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G
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227316
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A
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$
0
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361325
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I
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As Co-Trustee
(6)
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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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Employee Stock Option (Right to Buy)
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$
14.875
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(7)
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11/29/2009
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Common Stock, $.10 par value
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9750
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9750
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D
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Employee Stock Option (Right to Buy)
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$
12.5417
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(7)
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11/30/2010
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Common Stock, $.10 par value
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15000
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15000
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D
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Employee Stock Option (Right to Buy)
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$
7.1133
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(7)
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3/10/2013
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Common Stock, $.10 par value
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6000
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6000
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D
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Employee Stock Option (Right to Buy)
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$
13.32
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(8)
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12/17/2017
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Common Stock, $.10 par value
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20000
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20000
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D
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Restricted Stock Units
(9)
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(10)
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12/17/2017
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Common Stock, $.10 par value
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20000
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20000
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D
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Employee Stock Option (Right to Buy)
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$
6.39
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(11)
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4/6/2019
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Common Stock, $.10 par value
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8000
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8000
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D
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Explanation of Responses:
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(
1)
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Held in the reporting person's Employee Stock Ownership Plan account in the Company Savings Plan as of October 31, 2011.
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(
2)
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Held in the reporting person's Stock Fund under the reporting person's 401(k) Plan account in the Company Savings Plan as of October 31, 2011.
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(
3)
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Held as co-trustee, with the reporting person's brother and a director of the issuer, of a trust of which the reporting person is the beneficiary.
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(
4)
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Held as co-trustee, with the reporting person's brother and a director of the issuer, of trusts of which the reporting person's brother and or sister are beneficiaries.
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(
5)
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Held as co-trustee, with the reporting person's brother, sister and a director of the issuer, of a trust of which the reporting person is the beneficiary.
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(
6)
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Held as co-trustee, with the reporting person's brother, sister and a director of the issuer, of trusts of which the reporting person's brother or sister are beneficiaries.
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(
7)
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Currently exercisable in full.
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(
8)
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Options may be "earned" subject to the Company's achievement of certain performance goals measured at the end of the Company's 2012 fiscal year. Such options, to the extent so "earned," will vest in four equal annual installments on the 15th day of the third month of each of the Company's 2013, 2014, 2015 and 2016 fiscal years. The end of the Company's fiscal year is the Sunday nearest October 31, 2012.
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(
9)
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Each restricted stock unit represents the right to one share of common stock.
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(
10)
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Each share of common stock represented by a restricted stock unit may be "earned" subject to the Company's achievement of certain performance goals measured at the end of the Company's 2011 fiscal year. Such shares, to the extent so "earned," will vest in five equal annual installments on the 15th day of the third month of each of the Company's 2012, 2013, 2014, 2015 and 2016 fiscal years. The end of the Company's fiscal year is the Sunday nearest to October 31.
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(
11)
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The option is exercisable in 20% annual installments, on a cumulative basis, commencing April 7, 2010, one year after the date of grant of the option.
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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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SHAW STEVEN A
C/O VOLT INFORMATION SCIENCES, INC.
560 LEXINGTON AVENUE
NEW YORK, NY 10022
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X
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X
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PRESIDENT/CEO
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Signatures
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/s/ Steven A. Shaw
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12/14/2011
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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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