SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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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*
KEANE DANIEL G

(Last) (First) (Middle)
1801 ELMWOOD AVE

(Street)
BUFFALO NY 14207

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
MOD PAC CORP [ MPAC ]
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
3. Date of Earliest Transaction (Month/Day/Year)
01/17/2013
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X 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) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
$.01 Par Value Common Stock(1) 01/17/2013 M 31,921 A $5.392 31,921 D
$.01 Par Value Common Stock 406,905 I By Trust(2)
$.01 Par Value Common Stock 16,997 I By Spouse(3)
$.01 Par Value Class B Stock 14,995 I By Spouse(3)
$.01 Par Value Common Stock 25,000 I By Children(4)
$.01 Par Value Class B Stock 201,237 D
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) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 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: 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
Option $5.392 01/17/2013 M 31,921 01/24/2004 01/24/2013 $.01 PV Com Stk 0 $5.392 0 D
Option $8.44 08/20/2004 02/20/2014 $.01 PV Com Stk 28,000 28,000 D
Option $12.8 07/06/2005 01/06/2015 $.01 PV Com Stk 22,300 22,300 D
Option $11.68 06/21/2006 12/21/2015 $.01 PV Com Stk 22,300 22,300 D
Option $10 06/13/2007 12/13/2016 $.01 PV Com Stk 22,300 22,300 D
Option $7.36 06/20/2008 12/20/2017 $.01 PV Com Stk 26,000 26,000 D
Option $1.85 06/15/2009 12/15/2018 $.01 PV Com Stk 40,000 40,000 D
Option $4.37 06/16/2010 12/16/2019 $.01 PV Com Stk 25,000 25,000 D
Option $4.65 06/21/2011 12/21/2020 $.01 PV Com Stk 25,000 25,000 D
Option $5.9 06/02/2012 12/02/2021 $.01 PV Com Stk 12,500 12,500 D
Explanation of Responses:
1. Exercise of options
2. Mr. Keane transferred the shares of Common Stock reported on this line to a grantor trust (the "Trust") for the benefit of Mr. Keane's wife (with whom he shares a household) and their descendants. Mr. Keane disclaims any beneficial ownership in the shares held by the Trust and this report should not be deemed an admission that the reporting person is the beneficial ownership of the Trust's shares for purpose of Section 16 or for any other purpose.
3. Mr. Keane disclaims any beneficial ownership in shares held by his wife.
4. Mr. Keane disclaims any beneficial ownership in shares held by his children.
/s/ Daniel J. Geary, as Power of Attorney for Daniel G. Keane 01/17/2013
** 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.