SEC Form 4 · accession 0001638599-15-000338
JAMBA, INC. · JMBA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Dale Goss
Officer — SVP, Store Development
Period of report
Nov 12, 2015
Accepted (ET)
Nov 16, 2015 · 9:17 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001316898
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Nov 12, 2015 | M | 666 | $0.00 | A | 15,090 | D | |
| Common StockF2 | Nov 12, 2015 | F | 186 | $13.40 | D | 14,904 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Performance Share UnitF1 | $0.00 | Nov 12, 2015 | M | 666 | D | — | Aug 6, 2022 | Common Stock | 666 | 0 | D |
Explanation of responses
- F1Shares of common stock issued to the reporting person upon vesting of a performance share unit award granted on 08/06/2012.
- F2The securities reported in this column include 4,751 restricted stock units which give the Reporting Person a contingent right to receive at a future date one share of JMBA common stock for each restricted stock unit held as of the date of this filing.