SEC Form 4 · accession 0001140361-15-014530
COSI INC · COSI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Robert J Dourney
Officer — CEO and President · Director
Period of report
Apr 1, 2015
Accepted (ET)
Apr 6, 2015 · 4:40 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001171014
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock, par value $0.01F1 | Apr 1, 2015 | J | 1,701,050 | $0.00 | A | 2,530,214 | D | |
| Common Stock, par value $0.01F2 | Apr 1, 2015 | J | 17,182 | $0.00 | A | 17,182 | I | By spouse |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1These unregistered restricted shares were granted to the reporting person in consideration of the reverse triangular merger of Hearthstone Associates, LLC ("HA"), with and into a wholly-owned subsidiary of the issuer ("Merger"), which was completed on April 1, 2015, pursuant to the Election to Cause Merger Agreement dated March 18, 2014 ("Merger Agreement"), among the issuer, HA, and the owners of the issued and outstanding ownership interests of HA. The shares were fully vested upon issuance.
- F2These unregistered restricted shares were granted to the reporting person's spouse in consideration of the Merger, which was completed on April 1, 2015. The shares were fully vested upon issuance.