0001140361-12-050806.txt : 20121212 0001140361-12-050806.hdr.sgml : 20121212 20121212145403 ACCESSION NUMBER: 0001140361-12-050806 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121028 FILED AS OF DATE: 20121212 DATE AS OF CHANGE: 20121212 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SHAW JEROME CENTRAL INDEX KEY: 0001007671 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-09232 FILM NUMBER: 121258882 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: VOLT INFORMATION SCIENCES, INC. CENTRAL INDEX KEY: 0000103872 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HELP SUPPLY SERVICES [7363] IRS NUMBER: 135658129 STATE OF INCORPORATION: NY FISCAL YEAR END: 1031 BUSINESS ADDRESS: STREET 1: 1065 AVENUE OF THE AMERICAS STREET 2: 20TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10018 BUSINESS PHONE: 212-704-2400 MAIL ADDRESS: STREET 1: 1065 AVENUE OF THE AMERICAS STREET 2: 20TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10018 FORMER COMPANY: FORMER CONFORMED NAME: VOLT INFORMATION SCIENCES INC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: VOLT TECHNICAL CORP DATE OF NAME CHANGE: 19680913 5 1 doc1.xml FORM 5 X0306 5 2012-10-28 0 0 0 0000103872 VOLT INFORMATION SCIENCES, INC. VISI 0001007671 SHAW JEROME C/O VOLT INFORMATION SCIENCES, INC. 2401 NORTH GLASSELL STREET ORANGE CA 92865 0 1 0 0 Executive V.P. and Secretary Common Stock, $0.10 par value 2012-03-05 5 G 0 300000 0 D 1616194 D Common Stock, $0.10 par value 239659 I By GRATs Common Stock, $0.10 par value 2578 I By ESOP Common Stock, $0.10 par value 24721 I By 401(k) Plan Common Stock, $0.10 par value 354375 I As Co-Trustee Common Stock, $0.10 par value 9825 I By Spouse Employee Stock Option (Right to Buy) 6.39 2019-04-06 Common Stock $.10 par value 8000 8000 D Column 5 of Table 1 gives effect to all transactions, including Employee Stock Ownership Plan ("ESOP") distributions, 401(k) Plan contributions and distributions and contributions to, and all annuity distributions from, Grantor Retained Annuity Trusts ("GRATs") created by the reporting person through the end of the Issuer's fiscal year rather than the date set forth in Column 2. Amounts in Column 5 reflect holdings at the end of the Issuer's fiscal year rather than the date set forth in Column 2. Certain of the transactions may not be reportable and, therefore, amounts shown in Column 5 may not foot to the amount previously reported as owned. Held by GRATs created by the reporting person and of which the reporting person is the sole trustee and sole annuitant. Contributions to the GRATs by, and annuity distributions to, the reporting person are exempt from reporting pursuant to Rule 16a-13. The shares owned at the end of the fiscal year given effect to all contributions made to, and all annuity distributions received from, the GRATs since last reported. Held in the reporting person's ESOP account in the Company Savings Plan as of October 28, 2012. Gives effect to ESOP distributions since last reported which are exempt from reporting pursuant to Rule 16a-13. 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 28, 2012. Gives effect to 401(k) Plan contributions and distributions which are exempt from reporting pursuant to Rules 16a-3(f)(1)(i)(b) and 16a-13, respectively, since last reported. Held by the reporting person and his spouse as co-trustees of a trust for the benefit of the daughter of the reporting person. The filing of this statement shall not be construed as an admission that the reporting person is, for the purpose of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of these securities. 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. /s/ Jerome Shaw 2012-12-12