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FORM 5
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/ / Check box if no U.S. SECURITIES AND EXCHANGE COMMISSION
longer subject to WASHINGTON, DC 20549
Section 16. Form
4 or Form 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
obligations may
continue. See Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility
Instruction 1(b) Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person(1) 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to
Issuer (Check all applicable)
X Director 10% Owner
---- ---
Officer (give Other (Specify
---- title --- below)
Trubeck William L. below
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(Last) (First) (Middle) 3. IRS Identification 4. Statement for 7. Individual or Joint/Group Filing
Number of Reporting Month/Year (Check applicable line)
Person, if an Entity X Form filed by One Reporting
(Voluntary) ---- Person
3300 Fox Street 12/01 Form Filed by More Than One
------------------------------------------- ------------------- ---- Reporting Person
(Street) 5. If Amendment,
Long Lake, MN 55356 Date of Original
------------------------------------------- (Month/Year)
(City) (State) (Zip)
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TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Instr. 8) End of Issuer's Direct Benefi-
(Month/ Fiscal Year (D) or cial
Day/ ---------------------------- (Instr. 3 and 4) Indirect Owner-
Year) Amount (A) or (D) Price (I) ship
(Instr. 4) (Instr.
4)
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Common Stock - Directors'
Stock Compensation Plan 4/19/01 A 966 A N/A 5729 D
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Reminder: Report on a separate line for each class of securities beneficially owned directly or (Over)
indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
FORM 5 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
WILLIAM L. TRUBECK (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv-
Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- Day/ Disposed of (D) (Month/Day/ Secur-
ative Year) (Instr. 3, 4, Year) ity
Security and 5) (Instr. 5)
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Date Expira- Amount or
--------------- Exer- tion Title Number of
(A) (D) cisable Date Shares
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Directors' Stock Option Common
Award 19.50 1/2/01 A 2,000 7/1/01 1/2/06 Stock 2,000 19.50
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9. Number of 10. Ownership 11. Nature of
Derivative of Derivative Indirect
Securities Security: Beneficial
Beneficially Direct (D) Ownership
Owned at End or Indirect (I) (Instr. 4)
of Year (Instr. 4)
(Instr. 4)
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10,000 D
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Explanation of Responses:
/s/ WILLIAM L. TRUBECK February 4, 2002
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Signature of Reporting Person(1) 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. Page 2
If space provided is insufficient, see Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained in this form are not required to respond unless
the form displays a currently valid OMB number.