-----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, FgmLuT8Pj8E/fkGWCJmJVLIozqv7F1uiZQUeEXn7EWA2lSeab25r2kJZTM+dFFxF pdx4Wy1TaVWqZJqUM7caTg== 0001093975-99-000001.txt : 19990913 0001093975-99-000001.hdr.sgml : 19990913 ACCESSION NUMBER: 0001093975-99-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990901 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: 99709514 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: CHRISTENSEN TERRY N CENTRAL INDEX KEY: 0001093975 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 620 NORTH BEVERLY DRIVE CITY: BEVERLY HILLS STATE: CA ZIP: 90210 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 CHRISTENSEN, TERRY N. 620 North Beverly Drive Beverly Hills, CA 90210 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) (X) Director ( ) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) 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 | |4,507 (1) |A |$2.87 |4,507 |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 | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Checkers stock and then sub| | | | | | | | | | ject to a one-for-12 revers| | | | | | | | | | e 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)| | ___________________________________________________________________________________________________________________________________| Director Stock Option |$1.78 |8/17/|A | |A |A |8/17/|8/17/|Common Stock|10,000 | | |D | | (right to buy) | |99 | | | | |99 |09 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Director Stock Option |$13.19 |8/9/9|C (1| |A |A |5/11/|5/11/|Common Stock|2,488 | | |D | | (right to buy) | |9 |) | | | |96 |06 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Director Stock Option |$18.09 |8/9/9|C (1| |A |A |7/10/|7/10/|Common Stock|24,875 | | |D | | (right to buy) | |9 |) | | | |96 |01 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Director Stock Option |$17.37 |8/9/9|C (1| |A |A |5/11/|5/11/|Common Stock|2,488 | | |D | | (right to buy) | |9 |) | | | |97 |07 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Director Stock Option |$13.95 |8/9/9|C (1| |A |A |5/11/|5/11/|Common Stock|2,488 | | |D | | (right to buy) | |9 |) | | | |98 |08 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Director Stock Option |$4.15 |8/9/9|C (1| |A |A |5/11/|5/11/|Common Stock|2,488 | | |D | | (right to buy) | |9 |) | | | |99 |09 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Director Stock Option |$3.20 |8/9/9|C (1| |A |A |2/12/|2/12/|Common Stock|33,167 | | |D | | (right to buy) | |9 |) | | | |98 |03 | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | |124,244 | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | ___________________________________________________________________________________________________________________________________|
Explanation of Responses: 1. Pursuant to the Agreement and Plan of Merger between Rally's Hamburgers, Inc. ("Rally's") and the Company effective August 9, 1999 options in Rally's held by the reporting person were exchanged for options in Checkers stock at a ratio of 1.99 for one and then subject to a one-for-12 reverse stock split. SIGNATURE OF REPORTING PERSON TERRY N. CHRISTENSEN -----END PRIVACY-ENHANCED MESSAGE-----