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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
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 Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Gilbert John F III C/O FAMOUS DAVE'S OF AMERICA, INC. 12701 WHITEWATER DRIVE, SUITE 200 MINNETONKA, MN 55343 |
X | Chief Executive Officer |
/s/ Paul Ziccarelli as attorney-in-fact for John F. Gilbert III | 01/17/2014 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Shares forfeited to the Issuer upon vesting of restricted stock to cover applicable federal and state withholding obligations under IRC sections 3101 and 3402, sections 31.3121(a)-1(e) and 31.3401-1(a)(4) of the Treasury Regulations, and MN Stat 290.92 and MN Admin Rule 8092.0700. |
(2) | Represents a restricted stock grant wwith transfer and forfeiture restrictions on the shares that lapse as follows: 870 shares on each of 12/31/2014, 12/31/2015, 12/31/2016 and 12/31/2017; and 868 shares on 12/31/2018. |
(3) | In addition to the present grant, includes (i) a restricted stock grant subject to remaining restrictions that lapse as to 3,000 shares on each of 8/2/2014, 8/2/2015 and 8/2/2016; (ii) a restricted stock grant subject to remaining restrictions that lapse in 4 equal annual installments of 30,000 shares each beginning on 10/8/2014; and (iii) a restricted stock grant subject to remaining restrictions that lapse in 4 equal annual installments of 1,741 shares each beginning on 12/31/2014. |