Statement of Changes in Beneficial Ownership (4)
20 September 2017 - 2:18AM
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).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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
*
KNUTSON SUSAN M
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2. Issuer Name
and
Ticker or Trading Symbol
Good Times Restaurants Inc.
[
GTIM
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
Controller
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(Last)
(First)
(Middle)
141 UNION BLVD., #400
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3. Date of Earliest Transaction
(MM/DD/YYYY)
9/18/2017
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(Street)
LAKEWOOD, CO 80228
(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
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9/18/2017
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S
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2910
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D
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$2.60
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17000
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D
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Common Stock
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9/18/2017
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S
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4764
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D
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$2.6001
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12236
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D
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Incentive Stock Option
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$4.41
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11/14/2011
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11/14/2018
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Common
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2034
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2.034
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D
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Incentive Stock Option
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$3.45
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11/6/2012
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11/6/2019
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Common
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1267
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3301
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D
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Incentive Stock Option
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$1.56
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12/13/2013
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12/13/2020
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Common
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5323
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8624
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D
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Incentive Stock Option
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$2.31
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1/2/2016
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1/2/2023
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Common
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18132
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26756
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D
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Incentive Stock Option
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$2.48
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11/21/2016
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11/21/2024
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Common
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10000
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36756
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D
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Incentive Stock Option
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$7.79
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(1)
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3/13/2025
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Common
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5520
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42276
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D
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Incentive Stock Option
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$5.29
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(2)
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11/23/2025
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Common
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4159
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46435
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D
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Restricted Stock Unit
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$0.00
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(3)
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11/23/2018
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Common
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3493
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49928
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D
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Incentive Stock Option
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$3.15
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(4)
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11/16/2026
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Common
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7700
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57628
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D
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Restricted Stock Unit
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$0.00
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(5)
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11/16/2019
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Common
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6191
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63819
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D
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Explanation of Responses:
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(1)
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The Incentive Stock Options vest in three equal annual installments with the first installment vesting March 13, 2016.
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(2)
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The Incentive Stock Options vest in three equal annual installments with the first installment vesting November 23, 2016.
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(3)
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The reporting person was granted 5,240 restricted stock units on November 23, 2015 vesting at 1/3 of the total granted amount over three years. Such restricted stock units were previously reported in Table II on a Form 4 filed with the Securities and Exchange Commission.
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(4)
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The Incentive Stock Options vest in three equal annual installments with the first installment vesting November 16, 2017.
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(5)
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The reporting person was granted 6,191 restricted stock units on November 16, 2016 vesting at 1/3 of the total granted amount over three years. Such restricted stock units were previously reported in Table II on a Form 4 filed with the Securities and Exchange Commission.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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KNUTSON SUSAN M
141 UNION BLVD., #400
LAKEWOOD, CO 80228
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Controller
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Signatures
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Susan M. Knutson
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9/19/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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