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