0000082166-17-000016.txt : 20170214 0000082166-17-000016.hdr.sgml : 20170214 20170214143017 ACCESSION NUMBER: 0000082166-17-000016 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170131 FILED AS OF DATE: 20170214 DATE AS OF CHANGE: 20170214 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: RAVEN INDUSTRIES INC CENTRAL INDEX KEY: 0000082166 STANDARD INDUSTRIAL CLASSIFICATION: UNSUPPORTED PLASTICS FILM & SHEET [3081] IRS NUMBER: 460246171 STATE OF INCORPORATION: SD FISCAL YEAR END: 0131 BUSINESS ADDRESS: STREET 1: 205 E 6TH ST STREET 2: PO BOX 5107 CITY: SIOUX FALLS STATE: SD ZIP: 57117 BUSINESS PHONE: 6053362750 MAIL ADDRESS: STREET 1: P O BOX 5107 CITY: SIOUX FALLS STATE: SD ZIP: 57117-5107 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Andringa Jason M CENTRAL INDEX KEY: 0001576516 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-07982 FILM NUMBER: 17607147 MAIL ADDRESS: STREET 1: PO BOX 5107 CITY: SIOUX FALLS STATE: SD ZIP: 57117 5 1 wf-form5_148710060252565.xml FORM 5 X0306 5 2017-01-31 0 0 0 0000082166 RAVEN INDUSTRIES INC RAVN 0001576516 Andringa Jason M PO BOX 5107 SIOUX FALLS SD 57117 1 0 0 0 Common Stock 9170 D Deferred Stock Units Common Stock 16054.655 16054.655 D Each Deferred Stock Unit is the economic equavalent of one share of RAVN Common Stock. As permitted under the Issuer's Deferred Stock Compensation Plan for Directors, the Reporting Person has elected to defer receipt of the common stock underlying these Units until 2 months after his retirement from the Board. Total reflects units credited as follows: Dividends of 107.064 units on 7/22/16, 97.548 units on 10/28/16 and 86.854 units on 1/20/17. /s/ Jason M. Andringa 2017-02-01