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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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*
DOURNEY ROBERT J

(Last) (First) (Middle)
294 WASHINGTON STREET, SUITE 510

(Street)
BOSTON MA 02108

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
COSI INC [ COSI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
CEO and President
3. Date of Earliest Transaction (Month/Day/Year)
05/11/2015
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock, par value $0.01 05/11/2015 A 135,747(1) A $0 2,665,961 D
Common Stock, par value $0.01 05/11/2015 A 67,873(2) A $0 2,733,834 D
Common Stock, par value $0.01 17,182 I By spouse
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. These restricted shares were granted to the reporting person on May 11, 2015, under the Amended and Restated Omnibus Plan, as an annual bonus for 2014 performance. Fifty percent (50%) of the shares vested immediately upon grant, and fifty percent (50%) of the shares will vest on March 1, 2016, provided the reporting person remains continuously employed by the Company through the vesting date.
2. These restricted shares were granted to the reporting person on May 11, 2015, under the Amended and Restated Omnibus Plan, as long-term stock incentive for 2014 performance. Fifty percent (50%) of the shares will vest in four equal annual installments commencing on the first anniversary of the date of award, provided that the reporting person remains in the continuous employ of the Company through each such vesting date. Fifty percent (50%) of the shares will vest in four equal installments commencing on the date of award on the first day the price exceeds the specified price targets for a period of 30 consecutive trading days: $3.50, $4.00, $4.50 and $5.00, provided that the reporting person remains in the continuous employ of the Company through each such vesting date.
Remarks:
/s/ Vicki J. Baue, Attorney In Fact 05/13/2015
** 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.