SEC Form 5 · accession 0001394156-19-000006
Diversified Restaurant Holdings, Inc. · SAUC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
T. Michael Ansley
Officer — Chairman of the Board · Director · 10% Owner
Period of report
Dec 30, 2018
Accepted (ET)
Jan 11, 2019 · 3:23 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001394156
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Dec 6, 2018 | G | 100,000 | $0.00 | D | 2,214,557 | D | |
| Common StockF1 | holding | — | — | — | 8,000,000 | I | By reporting person and wife through family limited liability company | |
| Common StockF2 | holding | — | — | — | 9,000 | I | By reporting person as UGMA custodian for children | |
| Common StockF2 | holding | — | — | — | 9,000 | I | By reporting person as UGMA custodian for children |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Reporting person transferred these shares to a family limited liability company of which the reporting person is the sole voting member with sole dispositive power over the shares, and the reporting person and his wife are the sole beneficial owners.
- F2The reporting person disclaims beneficial ownership of these shares and this report shall not be deemed an admission that the reporting person is the beneficial owner of these shares for purposes of Section 16 or for any other purpose