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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT 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 2270 (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 at End of Issuer's Fiscal Year (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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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MYERS JAMES M 9330 BALBOA AVENUE SAN DIEGO, CA 92123 |
 X |  |  |  |
Stephanie Brinsfield by Power of Attorney for James M. Myers | 09/28/2014 | |
**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) | Represents the total common stock equivalents (CSEs) credited to the reporting person's account each year in 2013 and 2014 under the Jack in the Box Inc. Deferred Compensation Plan for Non-Management Directors. The reporting person elected to defer receipt of annual cash retainers for service as a director. Upon each annual deferral, the reporting person was credited with CSEs (and fractions thereof). At the end of the reporting person's service as a director, the Company will issue to the reporting person the number of shares of common stock equal to the total number of CSEs credited to the reporting person's account at the time of distribution. Each annual deferral of cash compensation and the resulting CSEs were previously disclosed in the Director Compensation section and in the reporting person's beneficial shares in the Security Ownership of Directors and Management table in the Company's applicable year's proxy statement. |
(2) | Represents dividend equivalents (and fractions thereof) on the outstanding CSEs credited to the reporting person's account under the Jack in the Box Inc. Deferred Compensation Plan for Non-Management Directors on the Dividend Record Date for the quarterly dividends declared on 5/09/2014 and 7/31/2014, respectively. |