0001437749-12-011507.txt : 20121113
0001437749-12-011507.hdr.sgml : 20121112
20121113114635
ACCESSION NUMBER: 0001437749-12-011507
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120706
FILED AS OF DATE: 20121113
DATE AS OF CHANGE: 20121113
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Ansley T. Michael
CENTRAL INDEX KEY: 0001434679
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-53577
FILM NUMBER: 121197090
MAIL ADDRESS:
STREET 1: 21751 W. ELEVEN MILE ROAD
STREET 2: SUITE 208
CITY: SOUTHFIELD
STATE: MI
ZIP: 48076
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Diversified Restaurant Holdings, Inc.
CENTRAL INDEX KEY: 0001394156
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MANAGEMENT SERVICES [8741]
IRS NUMBER: 030606420
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1227
BUSINESS ADDRESS:
STREET 1: 27680 FRANKLIN ROAD
CITY: SOUTHFIELD
STATE: MI
ZIP: 48034
BUSINESS PHONE: (248) 223-9160
MAIL ADDRESS:
STREET 1: 27680 FRANKLIN ROAD
CITY: SOUTHFIELD
STATE: MI
ZIP: 48034
FORMER COMPANY:
FORMER CONFORMED NAME: Diversified Restaurants Holding, Inc.
DATE OF NAME CHANGE: 20070322
4
1
rdgdoc.xml
FORM 4(V) GIFTED SHARES
X0306
4
2012-07-06
0001394156
Diversified Restaurant Holdings, Inc.
DFRH
0001434679
Ansley T. Michael
27680 FRANKLIN ROAD
SOUTHFIELD
MI
48034
1
1
1
President and CEO
Common Stock
2012-07-06
5
G
0
20900
0
D
11122600
D
Common Stock
2012-07-06
5
G
0
9000
0
D
11113600
D
Common Stock
2012-07-06
5
G
0
9000
0
A
9000
I
By reporting person as UGMA custodian for children
Option to purchase common stock -- Right to Buy
2.50
2011-07-31
2016-07-31
Common Stock
10000
10000
D
Option to purchase common stock -- Right to Buy
2.50
2012-07-31
2016-07-31
Common Stock
10000
10000
D
Option to purchase common stock -- Right to Buy
2.50
2013-07-31
2016-07-31
Common Stock
10000
10000
D
Transfer of 9,000 shares of common stock to the reporting person as custodian for his three children under Uniform Gifts to Minors Act. The reporting person disclaims beneficial ownership of these shares, and this report shall not be deemed an admission that the reporting person is the beneficial owner of these shares for purposes of Section 16 or for any other purpose.
/s/ T. Michael Ansley
2012-11-13