-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, RBVWNMiwSq8PoiMExZgyW13ubAGEoF/h4r2yZaN7CN5OX6thBiWbAVF7BSk07iVx MozfH2xAVmYeoztcWANzVQ== 0001001348-97-000194.txt : 19971107 0001001348-97-000194.hdr.sgml : 19971107 ACCESSION NUMBER: 0001001348-97-000194 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19971101 FILED AS OF DATE: 19971106 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: GOOD TIMES RESTAURANTS INC CENTRAL INDEX KEY: 0000825324 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 841133368 STATE OF INCORPORATION: NV FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 000-18590 FILM NUMBER: 97709316 BUSINESS ADDRESS: STREET 1: 8620 WOLFF CT STE 330 CITY: WESTMINSTER STATE: CO ZIP: 80030 BUSINESS PHONE: 3034274221 MAIL ADDRESS: STREET 1: 8620 WOLFF COURT STREET 2: SUITE 330 CITY: WESTMINSTER STATE: CO ZIP: 80030 FORMER COMPANY: FORMER CONFORMED NAME: PARAMOUNT VENTURES INC DATE OF NAME CHANGE: 19900205 COMPANY DATA: COMPANY CONFORMED NAME: LEFERER SCOTT CENTRAL INDEX KEY: 0001048942 STANDARD INDUSTRIAL CLASSIFICATION: [] OTHER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 8620 WOLFF CT STREET 2: STE 330 CITY: WESTMINSTER STATE: CO ZIP: 80030 BUSINESS PHONE: 3038378800 MAIL ADDRESS: STREET 1: 601 CORPORATE CIRCLE CITY: GOLDEN STATE: CO ZIP: 80401 5 1 FORM 5 - 11/30/97 U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). () Form 3 Holdings Reported () Form 4 Transactions Reported 1. Name and Address of Reporting Person Lefever, Scott 8620 Wolff Court, Suite 330 Westminster, CO USA 80030 2. Issuer Name and Ticker or Trading Symbol Good Times Restaurants Inc. GTIM 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year 11/30/97 If Amendment, Date of Original (Month/Year) Relationship of Reporting Person to Issuer (Check all applicable) ( ) Director ( ) 10% Owner ( ) Officer (give title below) (x) Other (specify below) VP Good Times Drive Thru, Inc.
___________________________________________________________________________________________________________________________________ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1. Title of Security |2. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect | |Transaction| or Disposed of (D) | Securities |ect | Beneficial Ownership | |Date |Code| | Beneficially |(D)or | | | | | | A/| | Owned at |Indir | | | | | Amount | D | Price | End of Year |ect(I)| | ___________________________________________________________________________________________________________________________________| Common Stock Class A [1] |10/1/9|V |2074 |A |$.47 |4209.71 | | | |6 | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________ Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned | ___________________________________________________________________________________________________________________________________| 1.Title of Derivative |2.Con |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of| Security |version |Transaction rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect | |or Exer |Date |Code| rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise Pr | | | red(A) or Dis |Date(Month/| |Secu |Securities |(D)|Ownership | |ice of | | | posed of(D) |Day/Year) | |rity |Benefi |or | | |Deriva | | | |Date |Expir| | |ficially |Ind| | |tive | | | | A/|Exer-|ation| Title and Number | |Owned at |ire| | |Secu | | | | D |cisa-|Date | of Shares | |End of |ct | | |rity | | | Amount | |ble | | | |Year |(I)| | ___________________________________________________________________________________________________________________________________| Repriced Incentive Stock|$.50 |10/1/|V |50000 | |10/1/|10/1/|Common Stock|50,000 | | |D | | options [2] | |96 | | | |96 |06 |Class A | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________|
Explanation of Responses: 1. Shares were acqured pursuant to Issuer's 401(k) Savings and Investment Plan. 2. Outstanding Incentive Stock Options repriced to be exercisable at $.50 per share. Scott Lefever SIGNATURE OF REPORTING PERSON Scott Lefever DATE 11/6/97 -----END PRIVACY-ENHANCED MESSAGE-----