-----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, MWyiAnqhRA2SeA0LcKb8GUW1BcxVDFU4KBo4LYepq8Vxqa0cvhYsXkJH0YB76whE Lfzlxy9lT2oDMe1Ut0UYWA== 0001093972-99-000001.txt : 19990913 0001093972-99-000001.hdr.sgml : 19990913 ACCESSION NUMBER: 0001093972-99-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990809 FILED AS OF DATE: 19990910 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CHECKERS DRIVE IN RESTAURANTS INC /DE CENTRAL INDEX KEY: 0000879554 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 581654960 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-19649 FILM NUMBER: 99708894 BUSINESS ADDRESS: STREET 1: 14255 49TH STREET NORTH BLDG I CITY: CLEARWATER STATE: FL ZIP: 33762 BUSINESS PHONE: 7275192000 MAIL ADDRESS: STREET 1: 14255 49TH STREET NORTH BLDG I CITY: CLEARWATER STATE: FL ZIP: 33762 COMPANY DATA: COMPANY CONFORMED NAME: PEABODY RICHARD A CENTRAL INDEX KEY: 0001093972 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 14255 49TH STREET STREET 2: BUILDING 1 CITY: CLEARWATER STATE: FL ZIP: 33762 MAIL ADDRESS: STREET 1: 3916 STATE STREET STREET 2: SUITE 300 CITY: SANTA BARBARA STATE: CA ZIP: 93105 4 1 FORM 4 - SEPTEMBER 1999 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). 1. Name and Address of Reporting Person PEABODY, RICHARD A. 14255 49th Street North, Building 1 Clearwater, FL 33762 U.S.A. 2. Issuer Name and Ticker or Trading Symbol Checkers Drive-In Restaurants, Inc. CHKR 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year September 1999 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Senior Vice President and Chief Financial Officer 7. Individual or Joint/Group Filing (Check Applicable Line) (X) Form filed by One Reporting Person ( ) Form filed by More than One Reporting Person
___________________________________________________________________________________________________________________________________ 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 | | | | | Beneficially |(D)or | | | | | | | A/| | Owned at |Indir | | | Date |Code|V| Amount | D | Price | End of Month |ect(I)| | ___________________________________________________________________________________________________________________________________| Common Stock |8/9/99|C | |1,658 (1) |A |$9.05 |2,575 |D | | - -----------------------------------------------------------------------------------------------------------------------------------| 1. Pursuant to the Agreeme| | | | | | | | | | nt and Plan of Merger betwe| | | | | | | | | | en Rally's | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Hamburgers, Inc. ("Rally's"| | | | | | | | | | ) and the Company effective| | | | | | | | | | 8/9/99 shares of | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Rally's held by the reporti| | | | | | | | | | ng person were exchanged fo| | | | | | | | | | r 1.99 shares | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| of Checker's stock and then| | | | | | | | | | subject to a one-for-12 re| | | | | | | | | | verse stock split. | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| ___________________________________________________________________________________________________________________________________| ___________________________________________________________________________________________________________________________________ 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 | | | rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise | | | red(A) or Dis |Date(Month/| |Secu |Securities |(D)|Ownership | |Price 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 |Date |Code|V| Amount | |ble | | | |Month |(I)| | ___________________________________________________________________________________________________________________________________| Employee Stock Option |$3.20 |8/9/9|C | |A |A |(2) |4/27/|Common Stock|3,483 | | |D | | (right to buy) | |9 (1)| | | | | |03 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | |16,316 | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | ___________________________________________________________________________________________________________________________________|
Explanation of Responses: 1. Options originally granted under the stock option plan of Rally's Hamburgers, Inc. which were converted to options in Checkers in connection with the merger between Rally's and Checkers dated 8/9/99. 2. Options vest as follows: 1/3 on 4/27/99, 1/3 on 4/27/00, and 1/3 on 4/27/01. SIGNATURE OF REPORTING PERSON RICHARD A. PEABODY -----END PRIVACY-ENHANCED MESSAGE-----