SEC FORM
4
SEC Form 4
FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
CRACKER BARREL OLD COUNTRY STORE, INC
[ CBRL ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
X |
Officer (give title below) |
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Other (specify below) |
SVP Marketing
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3. Date of Earliest Transaction
(Month/Day/Year) 09/27/2017
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
09/27/2017 |
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A |
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337
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A |
$0.00
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1,429 |
D |
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of Responses: |
Remarks: |
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Donald H. Hoffman by Richard M. Wolfson, Attorney-in-Fact |
09/29/2017 |
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** Signature of Reporting Person |
Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* 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). |
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
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 Number. |
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that the undersigned,
Donald H. Hoffman, hereby appoints Jill Golder or Michael J. Zylstra, or either
of them, to be the undersigned's true and lawful attorney, for him, and in his
name, place and stead to execute, acknowledge, deliver and file, by mail,
delivery service or electronically, Forms 3, 4 and 5 (including amendments to
those forms) with respect to securities of Cracker Barrel Old Country Store,
Inc. (the "Company") required to be filed with the Securities and Exchange
Commission, national securities exchanges and the Company pursuant to Section
16(a) of the Securities Exchange Act of 1934 and the rules and regulations
under that Act, granting to Jill Golder or Michael J. Zylstra full power and
authority to perform all acts necessary to the completion of those purposes.
The undersigned agrees that the attorney-in-fact, Jill Golder or
Michael J. Zylstra, may rely entirely on information furnished orally or in
writing by the undersigned to any specified attorney-in-fact. The undersigned
also agrees to indemnify and hold the Company and the attorney-in-fact harmless
against any losses, claims, damages or liabilities (or actions or proceedings
in these respects) that arise out of or are based upon any untrue statements or
omission of necessary facts in the information provided by the undersigned to
the attorney-in-fact for any legal or other expenses reasonably incurred in
connection with investigating, defending against or resolving any such loss,
claim, damage, liability or action.
The validity of this Power of Attorney shall not be affected in any
manner by reason of the execution, at any time, of other powers of attorney by
the undersigned in favor of persons other than those named in this document.
The undersigned agrees and represents to those dealing with my
attorney-in-fact, Jill Golder or Michael J. Zylstra, that this Power of
Attorney is for indefinite duration and may be voluntarily revoked by me only
by written notice to the specified attorney-in-fact, delivered by registered
mail or certified mail, return receipt requested.
WITNESS THE EXECUTION OF THIS POWER on March 30, 2017.
/s/ Donald H. Hoffman
Donald H. Hoffman