Statement of Changes in Beneficial Ownership (4)
March 10 2020 - 12:58PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
SAMPSON RANDALL D |
2. Issuer Name and Ticker or Trading Symbol
Canterbury Park Holding Corp
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CPHC
]
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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 and CEO |
(Last)
(First)
(Middle)
1100 CANTERBURY ROAD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/6/2020 |
(Street)
SHAKOPEE, MN 55379
(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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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 3/6/2020 | | M | | 7133 | A | $11 | 264413 | D | |
Common Stock | 3/6/2020 | | F | | 2373 (1) | D | $11 | 262040 | D | |
Common Stock | | | | | | | | 342000 | I (2) | By Trust |
Common Stock | | | | | | | | 2000 | I (3) | By Trust |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 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 Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | The reporting person has elected to satisfy his tax withholding obligation in connection with a deferred stock grant by directing the Company to withhold shares otherwise issuable pursuant to the previously reported grant. |
(2) | The stock is owned by Marian Arlis Sampson 2012 Irrevocable Trust. The reporting person is a trustee of the Trust and disclaims any beneficial ownership of the stock, except to the extent of the reporting person's pecuniary interest in the shares [held by trust]. |
(3) | The stock is owned by Marian Arlis Sampson 2012 Revocable Trust. The reporting person is a trustee of the Trust and disclaims any beneficial ownership of the stock, except to the extent of the reporting person's pecuniary interest in the shares [held by trust]. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
SAMPSON RANDALL D 1100 CANTERBURY ROAD SHAKOPEE, MN 55379 | X | X | President and CEO |
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Signatures
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Alex Scheinost by Power of Attorney for Randall D. Sampson | | 3/10/2020 |
**Signature of Reporting Person | Date |
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