-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, JJ/As0yNPZCVB2OsoRmzpvKkUCq17uL8uVqhEYWDNdyEtLUkd2dM4HmqW+IAO76X QCEXigfN+mQVbOzLlou/pg== 0000897101-02-000838.txt : 20021127 0000897101-02-000838.hdr.sgml : 20021127 20021127120519 ACCESSION NUMBER: 0000897101-02-000838 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021127 FILED AS OF DATE: 20021127 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: DOMEIER MARY ELLEN CENTRAL INDEX KEY: 0001207846 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 1107 S FRONT STREET CITY: NEW ULM STATE: MN ZIP: 56073 BUSINESS PHONE: 5073546495 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: NEW ULM TELECOM INC CENTRAL INDEX KEY: 0000071557 STANDARD INDUSTRIAL CLASSIFICATION: TELEPHONE COMMUNICATIONS (NO RADIO TELEPHONE) [4813] IRS NUMBER: 410440990 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-03024 FILM NUMBER: 02842588 BUSINESS ADDRESS: STREET 1: 400 2ND ST N CITY: NEW ULM STATE: MN ZIP: 56073 BUSINESS PHONE: 5073544111 MAIL ADDRESS: STREET 1: P O BOX 697 CITY: NEW ULM STATE: MN ZIP: 56073 FORMER COMPANY: FORMER CONFORMED NAME: NEW ULM RURAL TELEPHONE CO DATE OF NAME CHANGE: 19840816 4 1 newulm-domeier025642_4.htm NEW ULM - DOMEIER FORM 4
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549

FORM 4

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

o Check this box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).

1. Name and Address of Reporting
Person*

   Domeier           Mary Ellen           
2. Issuer Name and Ticker or
Trading Symbol

New Ulm Telecom, Inc. NULM
3. I.R.S. Identification Number of Reporting
Person, if an entity (voluntary)

   
   
 
    (Last)       (First)       (Middle)

1107 S. Front Street
4. Statement for Month/Day/Year

11/27/02
5. If Amendment, Date of Original (Month/Year)

   
   
 
  (Street)

New Ulm                 MN              56073
6. Relationship of Reporting Person(s)
to Issuer (Check All Applicable)
7. Individual or Joint/Group Filing
(Check One)
   
(City)                (State)           (Zip)
  x  Director o  10% Owner   x Form filed by One Reporting Person
    o  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)

 
       
     

*   If the form is filed by more than one reporting person, see instruction 4(b)(v).

 

 


Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of Security
(Instr. 3)
2. Transaction Date
(Month/Day/Year)
2a. Deemed Execution
Date, if any.
(Month/Day/Year)
3. Transaction Code
(Instr. 8)


Code      ¦       V
4. Securities Acquired (A)
or Disposed of (D)
(Instr. 3, 4 and 5)
                  (A)
Amount   ¦   or    ¦    Price
                  (D)
5. Amount of Securities
Beneficially Owned
Following Reported
Transactions(s)
(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)
(Instr. 4)
7. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)

   New Ulm Telecom, Inc. Common Stock   9/30/02   P V   222 A   11.00    1,572     D  


Reminder:  Report on a separate line for each class of securities beneficially owned directly or indirectly.

Page 2

 


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
(Month/Day/Year)
3a. Deemed Execution Date,
if any.
(Month/Day/Year)
4. Transaction
Code
(Instr. 8)

   Code       ¦        V
5. Number of Derivative Securities
Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)

   (A)        ¦        (D)

                            

Page 3

 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

6. Date Exercisable and
Expiration Date
(Month/Day/Year)

Date                Expiration
Exercisable   ¦   Date
7. Title and Amount
of Underlying Securities
(Instr. 3 and 4)
                  Amount or
                  Number of
Title     ¦     Shares
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 Securities
Beneficially Owned
at End of Month
11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)

             

Explanation of Responses:
 

/s/  Mary Ellen Domeier   11/27/02

**Signature of Reporting Person
 
Date
 

**   Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
 
Note:   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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