PDF

SEC Form 4
FORM 4
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
OMB APPROVAL
Washington, D.C. 20549
OMB Number:
Check this box if no longer subject
to Section 16. Form 4 or Form 5
obligations may continue. See
Instruction 1(b).
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
hours per response:
0.5
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
1. Name and Address of Reporting Person*
2. Issuer Name and Ticker or Trading Symbol
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director
10% Owner
Officer (give title
Other (specify
X below)
below)
CTS CORP
[ CTS ]
Agrawal Ashish
3. Date of Earliest Transaction
(Month/Day/Year)
(Last)
3235-0287
Estimated average burden
(First)
(Middle)
02/11/2015
Vice President & CFO
1142 WEST BEARDSLEY AVE.
4. If Amendment, Date of Original Filed
(Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable
Line)
(Street)
X
ELKHART
IN
46514
(City)
(State)
(Zip)
Form filed by One Reporting Person
Form filed by More than One Reporting
Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)
4. Securities Acquired (A) or
3.
2. Transaction
2A. Deemed
Transaction Disposed Of (D) (Instr. 3, 4 and
Date
Execution Date,
5)
Code
(Month/Day/Year) if any
(Month/Day/Year) (Instr. 8)
Code
Common Stock
02/11/2015
F
V
Amount
720
(A) or
(D)
D
Price
$16.66
5. Amount of
Securities
Beneficially
Owned
Following
Reported
Transaction(s)
(Instr. 3 and 4)
6. Ownership
Form: Direct
(D) or
Indirect (I)
(Instr. 4)
23,456
7. Nature
of Indirect
Beneficial
Ownership
(Instr. 4)
D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
4.
3. Transaction
3A. Deemed
2.
1. Title of
Transaction
Execution Date,
Derivative Conversion Date
Code (Instr.
(Month/Day/Year) if any
or
Security
(Month/Day/Year) 8)
Exercise
(Instr. 3)
Price of
Derivative
Security
Code
V
6. Date Exercisable and
5.
Expiration Date
Number
(Month/Day/Year)
of
Derivative
Securities
Acquired
(A) or
Disposed
of (D)
(Instr. 3,
4 and 5)
(A)
(D)
Date
Expiration
Exercisable Date
7. Title and
Amount of
Securities
Underlying
Derivative
Security
(Instr. 3 and
4)
Title
11. Nature
10.
8. Price of 9. Number of
Ownership of Indirect
Derivative derivative
Beneficial
Form:
Securities
Security
Ownership
Direct (D)
Beneficially
(Instr. 5)
or Indirect (Instr. 4)
Owned
(I) (Instr.
Following
4)
Reported
Transaction(s)
(Instr. 4)
Amount
or
Number
of
Shares
Explanation of Responses:
/s/ Robert J. Patton, as
Attorney-in-fact
02/13/2015
** Signature of Reporting Person
Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see
Instruction 4
(b)(v).
** 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.