Statement of Changes in Beneficial Ownership (4)
November 18 2021 - 3:16PM
Edgar (US Regulatory)
FORM 4
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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).
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
*
LEFEVER SCOTT |
2. Issuer Name and Ticker or Trading Symbol
Good Times Restaurants Inc.
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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) Vice President of Operations |
(Last)
(First)
(Middle)
651 CORPORATE CIRCLE, SUITE 200 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/16/2021 |
(Street)
GOLDEN, CO 80401
(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 | 11/16/2021 | | M(1) | | 3186 | A | $0.00 | 6323 | D | |
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 |
Restricted Stock Unit | $0.00 | 11/16/2021 | | M | | | 3186 (1) | 11/16/2021 | 11/16/2021 | Common Stock | 0 | $0.00 | 0 | D | |
Incentive Stock Options (Right to buy) | $5.29 | | | | | | | 11/23/2015 (2) | 11/23/2025 | Common Stock | 7089 | | 7089 | D | |
Incentive Stock Options (Right to Buy) | $3.15 | | | | | | | 11/16/2016 (3) | 11/16/2026 | Common Stock | 12500 | | 12500 | D | |
Incentive Stock Options (Right to buy) | $3.55 | | | | | | | 6/27/2018 (4) | 6/27/2028 | Common Stock | 11424 | | 11424 | D | |
Incentive Stock Options (Right to buy) | $4.25 | | | | | | | 7/23/2018 (5) | 7/23/2028 | Common Stock | 4443 | | 4443 | D | |
Incentive Stock Options (Right to buy) | $4.66 | | | | | | | 11/16/2018 (6) | 11/16/2028 | Common Stock | 8703 | | 8703 | D | |
Explanation of Responses: |
(1) | Represents the conversion upon vesting of restricted stock awards into common stock (the "Converted Common Stock "). The reporting person was granted 9,556 restricted stock units on November 16, 2018 vesting at at 1/3 of the total granted over three years. Such Restricted Stock Units were previously reported in Table II on a Form 4 filed with the Securities and Exchange Commission. |
(2) | The Reporting Person was granted 7,089 Incentive Stock Options (Right to Buy) on November 23, 2015 vesting at 1/5 of the total amount granted over five years. Such Incentive Stock Options were previously reported in Table II on a Form 4 filed with the Securities and Exchange Commission. |
(3) | The Reporting Person was granted 12,500 Incentive Stock Options (Right to Buy) on November 16, 2016 vesting at 1/5 of the total amount granted over five years. Such Incentive Stock Options were previously reported in Table II on a Form 4 filed with the Securities and Exchange Commission. |
(4) | The Reporting Person was granted 11,424 Incentive Stock Options (Right to Buy) on June 27, 2018 vesting at 1/5 of the total amount granted over five years. Such Incentive Stock Options were previously reported in Table II on a Form 4 filed with the Securities and Exchange Commission. |
(5) | The Reporting Person was granted 4,443 Incentive Stock Options (Right to Buy) on July 23, 2018 vesting at 1/5 of the total amount granted over five years. Such Incentive Stock Options were previously reported in Table II on a Form 4 filed with the Securities and Exchange Commission. |
(6) | The Reporting Person was granted 8,703 Incentive Stock Options (Right to Buy) on November 16, 2018 vesting at 1/5 of the total amount granted over five years. Such Incentive Stock Options were previously reported in Table II on a Form 4 filed with the Securities and Exchange Commission. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
LEFEVER SCOTT 651 CORPORATE CIRCLE, SUITE 200 GOLDEN, CO 80401 |
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| Vice President of Operations |
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Signatures
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Scott G. LeFever | | 11/18/2021 |
**Signature of Reporting Person | Date |
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