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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 | ||||||||
Prepaid Variable Share Forward | (1) | 05/25/2005 | J/K(1) | 150,000 | (1) | (1) | Common Stock | 150,000 | (1) | 150,000 | D | ||||
Prepaid Variable Share Forward | (1) | 05/25/2005 | J/K(1) | 150,000 | (1) | (1) | Common Stock | 150,000 | (1) | 150,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SNYDER MICHAEL J 6312 S. FIDDLER'S GREEN CIRCLE SUITE 200 N GREENWOOD VILLAGE, CO 80111 |
X | CEO/President |
/s/ James P. McCloskey, Attorney in Fact | 05/27/2005 | |
**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) | The reporting person entered into a pre-paid variable share forward contract on May 25, 2005 relating to 300,000 shares of common stock (the "Common Stock") of Red Robin Gourmet Burgers, Inc. At this time, the price to be received by the reporting person and certain other terms have not been finally established. Upon finalization of the contract, the reporting person will be paid an amount in cash and will agree to deliver a 150,000 of the shares of the Common Stock in each of November 2006 and May 2007 (or an earlier date if the contract is terminated early) pursuant to formula to be established upon completion of the contract. The reporting person will file an amendment to this Form 4 setting forth the specific terms of the transaction upon finalization of the transaction. |