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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 | |
TEHLE DAVID M 9330 BALBOA AVENUE SAN DIEGO, CA 92123 |
X |
STEPHANIE BRINSFIELD by Power of Attorney for David M. Tehle | 01/04/2017 | |
**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 corrects the number of dividend equivalents credited to the reporting person's account in connection with a quarterly dividend paid on compensation previously deferred by the director under the Jack in the Box Inc. Deferred Compensation Plan for Non-Management Directors. The dividend was declared on November 17, 2016, and paid on December 16, 2016. The amount of dividend equivalents was previously miscalculated due to an administrative error. |
(2) | This corrects the number of dividend equivalents credited to the reporting person's account in connection with a quarterly dividend paid on vested Restricted Stock Units that were granted on 2/23/2015 and were deferred by the reporting person until his or her termination of board service. The dividend was declared on November 17, 2016, and paid on December 16, 2016. The amount of dividend equivalents was previously miscalculated due to an administrative error. |