SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
DAHLBERG KENNETH H

(Last) (First) (Middle)
1600 UTICA AVE. S., SUITE 700

(Street)
MINNEAPOLIS MN 55416

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/20/2003
3. Issuer Name and Ticker or Trading Symbol
BUFFALO WILD WINGS INC [ BWLD ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. 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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 505,633 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (right to buy) (1) 07/25/2006 Common Stock 1,800 $2.5 D
Stock Option (right to buy) (1) 01/29/2008 Common Stock 900 $4.15 D
Stock Option (right to buy) (1) 06/18/2008 Common Stock 900 $5 D
Stock Option (right to buy) (1) 08/20/2008 Common Stock 900 $5 D
Stock Option (right to buy) (1) 05/20/2009 Common Stock 4,500 $3.35 D
Stock Option (right to buy) (1) 05/23/2010 Common Stock 4,500 $3.9 D
Stock Option (right to buy) (1) 05/23/2011 Common Stock 3,000 $7.5 D
Stock Option (right to buy) (1) 09/05/2012 Common Stock 667 $11.25 D
Stock Option (right to buy) (2) 12/05/2012 Common Stock 667 $11.25 D
Stock Option (right to buy) (3) 03/06/2013 Common Stock 667 $12.75 D
Stock Option (right to buy) (4) 05/29/2013 Common Stock 250 $18.15 D
Warrant (1) 03/26/2004 Common Stock 30,000 $3.35 I By Carefree Capital, Inc.
Warrant (1) 05/01/2004 Common Stock 5,104 $3.35 I By Carefree Capital, Inc.
Series A Preferred Stock (5) (5) Common Stock 719,506 (5) I By Carefree Capital Partners, L.P.
Explanation of Responses:
1. Currently exercisable.
2. Original option (667 shares) exercisable: 167 shares on December 5, 2003, December 5, 2004 and December 5, 2005 and 166 shares on December 5, 2006.
3. Original option (667 shares) exercisable: 167 shares on March 6, 2004, March 6, 2005 and March 6, 2006 and 166 shares on March 6, 2007.
4. Original option (250 shares) exercisable: 63 shares on May 29, 2004 and May 29, 2005 and 62 shares on May 29, 2006 and May 29, 2007.
5. Series A Preferred Stock (1,199,177) shares) is convertible at any time into Common Stock at a ratio of .60-for-1 share.
Remarks:
Kenneth H. Dahlberg 11/20/2003
** 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 5 (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.
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