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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 | |
Dash Jonathan 9701 WILSHIRE BOULEVARD SUITE 1110 BEVERLY HILLS, CA 90212 |
X | |||
DASH ACQUISITIONS LLC 9701 WILSHIRE BOULEVARD SUITE 1110 BEVERLY HILLS, CA 90212 |
X |
/s/ Dash, Jonathan | 11/13/2009 | |
**Signature of Reporting Person | Date | |
By: Dash Acquisitions LLC; By: /s/ Jonathan Dash, President | 11/13/2009 | |
**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) | This Form 4 is filed jointly by Dash Acquisitions LLC ("Dash Acquisitions") and Jonathan Dash. |
(2) | Shares of the Issuer received by the Reporting Person in his capacity as a stockholder of Western Sizzlin Corp. ("WSC") pursuant to a special dividend by WSC payable to stockholders of WSC on a pro-rata basis, for no additional consideration. The special dividend was made pursuant to the terms of that certain merger agreement, dated October 22, 2009, by and among WSC, Grill Acquisition Corporation and the Issuer. |
(3) | Shares of the Issuer received by the Reporting Person in its capacity as a stockholder of WSC pursuant to a special dividend by WSC payable to stockholders of WSC on a pro-rata basis, for no additional consideration. The special dividend was made pursuant to the terms of that certain merger agreement, dated October 22, 2009, by and among WSC, Grill Acquisition Corporation and the Issuer. |
(4) | Represents shares held in client accounts managed by Dash Acquisitions over which Jonathan Dash has sole investment discretion. Accordingly, Dash Acquisitions and Jonathan Dash may be deemed to beneficially own these shares. Each of Dash Acquisitions and Jonathan Dash disclaims beneficial ownership of these shares except to the extent of his or its pecuniary interest therein. |