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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
WESTERN SIZZLIN CORP 401 ALBEMARLE AVENUE SE ROANOKE, VA 24013 |
X | |||
Western Investments Inc. 401 ALBEMARLE AVENUE SE ROANOKE, VA 24013 |
X | |||
Western Acquisitions L.P. 401 ALBEMARLE AVENUE SE ROANOKE, VA 24013 |
X | |||
BIGLARI, SARDAR C/O WESTERN SIZZLIN CORP. 401 ALBEMARLE AVENUE SE ROANOKE, VA 24013 |
X | X | Chairman and CEO |
By: Western Sizzlin Corp., By: /s/ Sardar Biglari, Chairman and Chief Executive Officer | 11/13/2009 | |
**Signature of Reporting Person | Date | |
By: Western Investments Inc., By: /s/ Sardar Biglari, Chairman and Chief Executive Officer | 11/13/2009 | |
**Signature of Reporting Person | Date | |
By: Western Acquisitions L.P., By: Western Investments Inc., General Partner, By: /s/ Sardar Biglari, Chairman and Chief Executive Officer | 11/13/2009 | |
**Signature of Reporting Person | Date | |
/s/ Biglari, Sardar | 11/13/2009 | |
**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) | This Form 4 is filed jointly by Western Sizzlin Corp. ("WSC"), Western Acquisitions L.P. ("Western Acquisitions"), Western Investments Inc. ("Western Investments") and Sardar Biglari. Sardar Biglari serves as the Chairman of the Board and Chief Executive Officer of the Issuer. WSC, Western Acquisitions and Western Investments no longer beneficially own in excess of 10% of the outstanding shares of Common Stock of the Issuer and, accordingly, are no longer subject to the reporting requirements of Section 16 of the Securities Exchange Act of 1934, as amended ("Section 16"), with respect to securities of the Issuer. Sardar Biglari, as the Chairman of the Board and Chief Executive Officer of the Issuer, remains subject to the reporting requirements of Section 16 and will continue to file statements of changes in beneficial ownership to the extent required thereunder. |
(2) | Transaction constitutes a special dividend by WSC payable to stockholders of WSC on a pro-rata basis, for no additional consideration, in the form of shares of Common Stock of the Issuer. The special dividend was made pursuant to the terms of that certain merger agreement, dated October 22, 2009, by and among WSC, Grill Acquisition Corporation and the Issuer. |
(3) | Shares owned directly by Western Acquisitions. Western Investments is the general partner of Western Acquisitions and a wholly-owned subsidiary of WSC. Sardar Biglari is the Chairman and Chief Executive Officer of each of Western Investments and WSC and has been delegated investment discretion over the securities owned by WSC. Accordingly, WSC, Western Investments and Sardar Biglari may be deemed to beneficially own the shares held directly by Western Acquisitions. Each of WSC, Western Investments and Sardar Biglari disclaims beneficial ownership of the shares held directly by Western Acquisitions except to the extent of his or its pecuniary interest therein. |