Statement of Changes in Beneficial Ownership (4)
October 01 2013 - 2:23PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Bashour Fouad Zouhair
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2. Issuer Name
and
Ticker or Trading Symbol
GRANITE CITY FOOD & BREWERY LTD.
[
GCFB
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
500 CRESCENT COURT, SUITE 250
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3. Date of Earliest Transaction
(MM/DD/YYYY)
9/30/2013
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(Street)
DALLAS, TX 75201
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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9/30/2013
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J
(1)
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46836
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A
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$0.00
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3545859
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I
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By Concept Development Partners LLC
(2)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Stock Option (right to buy)
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$2.02
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5/10/2014
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5/10/2023
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Common Stock
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4950
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4950
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D
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Stock Option (right to buy)
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$2.21
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5/10/2013
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5/10/2022
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Common Stock
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4525
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4525
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D
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Stock Option (right to buy)
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$3.55
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6/14/2012
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6/14/2021
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Common Stock
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3000
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3000
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D
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Series A Convertible Preferred Stock
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(3)
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5/10/2011
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(4)
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Common Stock
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6000000
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3000000
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I
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By Concept Development Partners LLC
(2)
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Explanation of Responses:
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(
1)
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On September 30, 2013, the Issuer paid a quarterly dividend in the form of 50% cash and 50% common stock on its outstanding Series A Convertible Preferred Stock ("Preferred Stock"), resulting in the issuance of 46,836 shares of common stock to Concept Development Partners LLC, the sole holder of the Issuer's Preferred Stock.
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(
2)
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The reporting person has an indirect pecuniary interest in the shares reported herein.
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(
3)
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Each share of the Preferred Stock is convertible into two shares of common stock.
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(
4)
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The Preferred Stock may be converted into common stock of the Issuer at any time prior to December 31, 2014. The Preferred Stock will automatically convert to common stock of the Issuer on the first business day on or after December 31, 2014, on which the average of the closing sale prices of the Issuer's common stock on the OTCQB (or other principal exchange or market on which the common stock is then traded) for the trading days within the 90 calendar day period ending on the date prior to such first business day is greater than $4.00 per share (as adjusted for stock splits, distributions or other combinations).
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Bashour Fouad Zouhair
500 CRESCENT COURT, SUITE 250
DALLAS, TX 75201
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X
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X
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Signatures
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/s/ Monica A. Underwood, attorney-in-fact
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10/1/2013
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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