Statement of Changes in Beneficial Ownership (4)
November 18 2020 - 03:00PM
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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
|
OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
|
Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
|
|
| 1. Name
and Address of Reporting Person * LEFEVER
SCOTT |
2. Issuer Name and Ticker or Trading
Symbol Good Times Restaurants Inc. [ GTIM ] |
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)
141 UNION BLVD., #400 |
3. Date of Earliest Transaction (MM/DD/YYYY)
11/16/2020
|
|
(Street)
LAKEWOOD, CO 80228
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
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. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. 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 |
|
Common Stock |
11/16/2020 |
|
M(1) |
|
3185 |
A |
$0.00 |
52167 |
D |
|
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
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 Units |
$0.00 |
11/16/2020 |
|
M |
|
|
3185 (1) |
11/16/2020 (2) |
11/16/2021 |
Common Stock |
3185 |
$0.00 |
3186 |
D |
|
|
Restricted Stock Units |
$0.00 |
|
|
|
|
|
|
6/27/2021 (3) |
6/27/2021 |
Common Stock |
3138 |
|
3138 |
D |
|
|
Incentive Stock Options (Right to
buy) |
$1.56 |
|
|
|
|
|
|
12/13/2010 (4) |
12/13/2020 |
Common Stock |
7984 |
|
17494 |
D |
|
|
Incentive Stock Options (Right to
Buy) |
$2.31 |
|
|
|
|
|
|
1/2/2013 (5) |
1/2/2023 |
Common Stock |
22346 |
|
39840 |
D |
|
|
Incentive Stock Options (Right to
buy) |
$2.48 |
|
|
|
|
|
|
11/21/2013 (6) |
11/21/2023 |
Common Stock |
13000 |
|
52840 |
D |
|
|
Incentive Stock Options |
$5.29 |
|
|
|
|
|
|
11/23/2015 (7) |
11/23/2025 |
Common Stock |
7089 |
|
59929 |
D |
|
|
Incentive Stock Options (Right to
Buy) |
$3.15 |
|
|
|
|
|
|
11/16/2016 (8) |
11/16/2026 |
Common Stock |
12500 |
|
72429 |
D |
|
|
Incentive Stock Options (Right to
buy) |
$3.55 |
|
|
|
|
|
|
6/27/2018 (9) |
6/27/2028 |
Common Stock |
11424 |
|
83853 |
D |
|
|
Incentive Stock Options (Right to
buy) |
$4.25 |
|
|
|
|
|
|
7/23/2018 (10) |
7/23/2028 |
Common Stock |
4443 |
|
88296 |
D |
|
|
Incentive Stock Options (Right to
buy) |
$4.66 |
|
|
|
|
|
|
11/16/2018 (11) |
11/16/2028 |
Common Stock |
8703 |
|
96999 |
D |
|
| Explanation of
Responses: |
| (1) |
Represents the conversion
upon vesting of Restricted Stock Units into Common
Stock. |
| (2) |
The Reporting Person was
granted 9,556 Restricted Stock Units on November 16, 2018 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. |
| (3) |
The Reporting Person was
granted 9,412 Restricted Stock Units on June 27, 2018 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. |
| (4) |
The Reporting Person was
granted 7,984 Incentive Stock Options (Right to Buy) on December
13, 2010 vesting at 1/5 of the total amount granted over five
years. |
| (5) |
The Reporting Person was
granted 22,346 Incentive Stock Options (Right to Buy) on January 2,
2013 vesting at 1/5 of the total amount granted over five
years. |
| (6) |
The Reporting Person was
granted 13,000 Incentive Stock Options (Right to Buy) on November
21, 2013 vesting at 1/5 of the total amount granted over five
years. |
| (7) |
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. |
| (8) |
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. |
| (9) |
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. |
| (10) |
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. |
| (11) |
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. |
Reporting
Owners
|
|
Reporting Owner Name / Address |
Relationships
|
|
Director |
10% Owner |
Officer |
Other |
LEFEVER SCOTT
141 UNION BLVD., #400
LAKEWOOD, CO 80228 |
|
|
Vice President of Operations |
|
Signatures
|
|
Scott G. LeFever |
|
11/18/2020 |
| **Signature
of Reporting Person |
Date |
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