UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 16,977 (15) | $ (14) | I | BY TRUST (2) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 16,977 (15) | $ (14) | I | BY TRUST (3) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 33,954 (15) | $ (14) | I | BY TRUST (4) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 33,954 (15) | $ (14) | I | BY TRUST (5) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 33,954 (15) | $ (14) | I | BY TRUST (6) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 33,954 (15) | $ (14) | I | BY TRUST (7) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 84,884 (15) | $ (14) | I | BY TRUST (8) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 33,954 (15) | $ (14) | I | BY TRUST (9) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 25,465 (15) | $ (14) | I | BY TRUST (10) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 8,488 (15) | $ (14) | I | BY TRUST (11) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 590,921 (15) | $ (14) | I | BY TRUST (12) |
COMMON MEMBERSHIP INTERESTS | Â (14) | Â (14) | CLASS A COMMON STOCK | 169,768 (15) | $ (14) | I | BY TRUST (13) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
POLSKY JACK R C/O SHAKE SHACK INC., 24 UNION SQUARE EAST, 5TH FLOOR NEW YORK, NY 10003 |
 |  X |  |  |
AMY WEISS-MEYER QUALIFIED MINOR'S TRUST C/O SHAKE SHACK INC., 24 UNION SQUARE EAST, 5TH FLOOR NEW YORK, NY 10003 |
 |  X |  |  |
ISAAC WEISS-MEYER QUALIFIED MINOR'S TRUST C/O SHAKE SHACK INC., 24 UNION SQUARE EAST, 5TH FLOOR NEW YORK, NY 10003 |
 |  X |  |  |
HALLIE MEYER QUALIFIED MINOR'S TRUST C/O SHAKE SHACK INC., 24 UNION SQUARE EAST, 5TH FLOOR NEW YORK, NY 10003 |
 |  X |  |  |
GRETCHEN MEYER QUALIFIED MINOR'S TRUST C/O SHAKE SHACK INC., 24 UNION SQUARE EAST, 5TH FLOOR NEW YORK, NY 10003 |
 |  X |  |  |
PEYTON MEYER QUALIFIED MINOR'S TRUST C/O SHAKE SHACK INC., 24 UNION SQUARE EAST, 5TH FLOOR NEW YORK, NY 10003 |
 |  X |  |  |
CHARLES MEYER QUALIFIED MINOR'S TRUST C/O SHAKE SHACK INC., 24 UNION SQUARE EAST, 5TH FLOOR NEW YORK, NY 10003 |
 |  X |  |  |
/s/ Ronald Palmese, Jr., Esq., Attorney-in-Fact for Jack R. Polsky | 02/17/2015 | |
**Signature of Reporting Person | Date | |
/s/ Ronald Palmese, Jr., Esq., Attorney-in-Fact for Amy Weiss-Meyer Qualified Minor's Trust | 02/17/2015 | |
**Signature of Reporting Person | Date | |
/s/ Ronald Palmese, Jr., Esq., Attorney-in-Fact for Isaac Weiss-Meyer Qualified Minor's Trust | 02/17/2015 | |
**Signature of Reporting Person | Date | |
/s/ Ronald Palmese, Jr., Esq., Attorney-in-Fact for Hallie Meyer Qualified Minor's Trust | 02/17/2015 | |
**Signature of Reporting Person | Date | |
/s/ Ronald Palmese, Jr., Esq., Attorney-in-Fact for Gretchen Meyer Qualified Minor's Trust | 02/17/2015 | |
**Signature of Reporting Person | Date | |
/s/ Ronald Palmese, Jr., Esq., Attorney-in-Fact for Peyton Meyer Qualified Minor's Trust | 02/17/2015 | |
**Signature of Reporting Person | Date | |
/s/ Ronald Palmese, Jr., Esq., Attorney-in-Fact for Charles Meyer Qualified Minor's Trust | 02/17/2015 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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) | Acquired pursuant to a subscription agreement entered into with Shake Shack Inc. (the "Issuer") in connection with the closing of the Issuer's initial public offering on February 4, 2015 (the "IPO"). One share of the Issuer's Class B common stock, par value $0.001 per share (the "Class B Common Stock"), was issued for each common membership interest in SSE Holdings, LLC (each an "LLC Interest") received pursuant to a reclassification of SSE Holdings, LLC that occurred in connection with the closing of the IPO. Pursuant to the Amended and Restated Certificate of Incorporation of the Issuer filed in connection with the IPO, the shares of Class B Common Stock (i) confer no incidents of economic ownership on the holders thereof, (ii) only confer voting rights on the holders thereof and (iii) may only be issued, on a one-for-one basis, to the permitted holders of LLC Interests. |
(2) | Held directly by the Amy Weiss-Meyer Qualified Minor's Trust, of which the Reporting Person is trustee. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(3) | Held directly by the Isaac Weiss-Meyer Qualified Minor's Trust, of which the Reporting Person is trustee. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(4) | Held directly by the Hallie Meyer Qualified Minor's Trust, of which the Reporting Person is trustee. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(5) | Held directly by the Gretchen Meyer Qualified Minor's Trust, of which the Reporting Person is trustee. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(6) | Held directly by the Peyton Meyer Qualified Minor's Trust, of which the Reporting Person is trustee. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(7) | Held directly by the Charles Meyer Qualified Minor's Trust, of which the Reporting Person is trustee. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(8) | Held directly by the RHF - NM 1999 Descendants Trust, of which the Reporting Person is a trustee and Michael C. McQuinn is a co-trustee. The shares and LLC Interests reported herein are also reported on a Form 3 filed by Michael C. McQuinn and the RHF - NM 1999 Descendants Trust. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(9) | Held directly by the RHF - TM 1999 Descendants Trust, of which the Reporting Person is a trustee and Michael C. McQuinn is a co-trustee. The shares and LLC Interests reported herein are also reported on a Form 3 filed by Michael C. McQuinn and the RHF - TM 1999 Descendants Trust. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(10) | Held directly by the VHP - Special Trust for Jack dtd 12/31/12, of which the Reporting Person is a trustee and Jonathan Graber is a co-trustee. The shares and LLC Interests reported herein are also reported on a Form 3 filed by the VHP - Special Trust for Jack dtd 12/31/12 and Jonathan Graber. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(11) | Held directly by the Jean Polsky Investment Trust dtd 3/21/97, of which the Reporting Person is a trustee. The shares and LLC Interests reported herein are also reported on a Form 3 filed by Jean Polsky Investment Trust dtd 3/21/97 and Jean Polsky. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(12) | Held directly by the Daniel H. Meyer 2012 Gift Trust u/a/d 10/31/12, of which the Reporting Person is a trustee and Audrey H. Meyer is a co-trustee. The shares and LLC Interests reported herein are also reported on a Form 3 filed by the Daniel H. Meyer 2012 Gift Trust u/a/d 10/31/12 and Audrey Meyer. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(13) | Held directly by the Roxanne Frank Revocable Trust, of which the Reporting Person is a trustee and Roxanne H. Frank is a co-trustee. The shares and LLC Interests reported herein are also reported on a Form 3 filed by Roxanne H. Frank and the Roxanne Frank Revocable Trust. The Reporting Person disclaims beneficial ownership of such shares and LLC Interests, as applicable, except to the extent of his pecuniary interest therein. |
(14) | Represents LLC Interests which are redeemable for an equal number of shares of the Issuer's Class A Common Stock or, at the election of the Issuer, cash equal to the volume-weighted average market price of such shares. The LLC Interests have no expiration date. |
(15) | Issued pursuant to a reclassification of SSE Holdings, LLC that occurred in connection with the closing of the IPO. The units in SSE Holdings, LLC held by the applicable trust prior to the reclassification were cancelled as part of the reclassification. The reclassification is further described in the Third Amended and Restated Limited Liability Company Agreement of SSE Holdings, LLC, which was filed with the Securities and Exchange Commission on January 20, 2015 as Exhibit 10.3 to Amendment No. 1 of the Issuer's Registration Statement on Form S11. |
 Remarks: Exhibit List:  Exhibit 24.1 - Power of Attorney for Jack R. Polsky, Exhibit 24.2 - Power of Attorney for the Amy Weiss-Meyer Qualified Minor's Trust, Exhibit 24.3 - Power of Attorney for the Isaac Weiss-Meyer Qualified Minor's Trust, Exhibit 24.4 - Power of Attorney for the Hallie Meyer Qualified Minor's Trust, Exhibit 24.5 - Power of Attorney for the Gretchen Meyer Qualified Minor's Trust, Exhibit 24.6 - Power of Attorney for the Peyton Meyer Qualified Minor's Trust, Exhibit 24.7 - Power of Attorney for the Charles Meyer Qualified Minor's Trust |