Statement of Changes in Beneficial Ownership (4)
13 September 2018 - 11:00PM
Edgar (US Regulatory)
FORM 4
[
X
]
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
Estimated average burden
hours per response...
0.5
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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
*
Depatie Michael A.
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2. Issuer Name
and
Ticker or Trading Symbol
JAMBA, INC.
[
JMBA
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
3001 DALLAS PARKWAY, SUITE 140
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3. Date of Earliest Transaction
(MM/DD/YYYY)
9/13/2018
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(Street)
FRISCO, TX 75034
(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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9/13/2018
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D
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39291
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D
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$13.00
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0
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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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Stock Option (right to buy)
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$11.10
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9/13/2018
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D
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2500
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(1)
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11/12/2020
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Common Stock
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2500
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$1.90
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0
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D
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Stock Option (right to buy)
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$11.975
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9/13/2018
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D
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5000
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(2)
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5/19/2021
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Common Stock
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5000
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$1.025
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0
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D
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Explanation of Responses:
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(1)
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The option, providing for vesting in two equal installments of 50% as of the close of business on February 10, 2011 and the remainder 50% upon the completion of the Company's 2011 annual stockholders meeting, and therefore already fully vested, was cancelled at the effective time of the merger between Jay Merger Sub, Inc. and the Issuer in exchange for a cash payment per share subject to the option determined by the difference between the $13 merger consideration per share and the exercise price of the option.
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(2)
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The option, providing for vesting of one-fourth of the shares subject to the option on each of August 19, 2011, November 19, 2011, February 19, 2012, and May 19, 2012 or the date of the Company's 2012 annual meeting of stockholders, and therefore already fully vested, was cancelled at the effective time of the merger between Jay Merger Sub, Inc. and the Issuer in exchange for a cash payment per share subject to the option determined by the difference between the $13 merger consideration per share and the exercise price of the option.
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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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Depatie Michael A.
3001 DALLAS PARKWAY
SUITE 140
FRISCO, TX 75034
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X
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Signatures
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/s/ Josh Nicosia, as attorney-in-fact for Michael A. Depatie
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9/13/2018
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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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