FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL 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). | |||||||||||||||||
Form 3 Holdings Reported. | |||||||||||||||||
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Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Command Center, Inc. [ CCNI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 12/31/2010 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||
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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 at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
Amount | (A) or (D) | Price | |||||||||||||
Common Shares(1) | 12/31/2006 | J4 | 300,000 | D | $0 | 4,512,004 | D | ||||||||
Common Shares(1) | 12/31/2006 | J4 | 300,000 | A | $0 | 3,496,750 | I | By WELSTAD FAMILY FOUNDATION | |||||||
Common Shares(2) | 02/20/2007 | J4 | 1,459,441 | D | $0 | 2,037,309 | I | SEE FOOTNOTE (2) | |||||||
Common Shares(3) | 02/20/2007 | J4 | 324,284 | A | $0 | 4,836,288 | D | ||||||||
Common Shares(4) | 12/04/2007 | J4 | 300,000 | D | $0 | 4,536,288 | D | ||||||||
Common Shares(4) | 12/04/2007 | J4 | 300,000 | A | $0 | 2,337,309 | I | By SPOUSE | |||||||
Common Shares(5) | 12/04/2007 | J4 | 550,000 | A | $1.5 | 5,086,288 | D | ||||||||
Common Shares(6) | 12/04/2007 | J4 | 240,436 | A | $1.5 | 5,326,724 | D | ||||||||
Common Shares(6) | 12/12/2007 | J4 | 133,333 | A | $1.5 | 2,470,642 | I | By WELSTAD SUPPORTING ORG | |||||||
Common Shares(7) | 04/17/2007 | G4 | 100,000 | D | $0 | 5,226,724 | D | ||||||||
Common Shares(8) | 12/28/2007 | G4 | 90,000 | D | $0 | 5,136,724 | D | ||||||||
Common Shares(9) | 09/10/2008 | J4 | 876,567 | D | $0 | 1,594,075 | I | SEE FOOTNOTE (9) | |||||||
Common Shares(10) | 09/10/2008 | J4 | 818,218 | A | $0 | 5,954,942 | D | ||||||||
Common Shares(11) | 10/13/2008 | J4 | 133,333 | D | $0 | 1,460,742 | I | By WELSTAD SUPPORTING ORG | |||||||
Common Shares(11) | 10/13/2008 | J4 | 133,333 | A | $0 | 1,594,075 | I | By WELSTAD FAMILY FOUNDATION | |||||||
Common Shares(12) | 06/25/2010 | J4 | 615,651 | D | $0 | 978,424 | I | SEE FOOTNOTE (12) | |||||||
Common Shares(13) | 06/25/2010 | J4 | 410,434 | A | $0 | 6,365,376 | D | ||||||||
Common Shares(14) | 07/06/2010 | P4 | 2,750,000 | A | $0.08 | 9,115,377 | D | ||||||||
Common Shares(15) | 10/13/2010 | J4 | 168,946 | D | $0 | 809,478 | I | By SACRAMENTO TEMP STAFFING SVCS, LLC | |||||||
Common Shares(15) | 10/13/2010 | J4 | 77,342 | A | $0 | 9,192,718 | D |
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) | 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) | |||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Stock Purchase Warrant(16) | $0.08 | 07/06/2010 | 4P | 1,375,000 | 07/06/2010 | 04/15/2015 | Common Shares | 1,375,000 | $0.08 | 1,375,000 | D | |||
Stock Purchase Option | $0.19 | 05/06/2010 | 4A | 500,000 | 05/06/2011 | 05/06/2015 | Common Shares | 500,000 | $0 | 1,875,000 | D |
Explanation of Responses: |
1. Transfer from direct ownership to indirect ownership via Welstad Family Foundation. |
2. The disposition relates to shares owned indirectly that are now being converted to direct ownership. The disposition removes the shares from indirect ownership as follows: 579,277 shares owned via Everyday Staffing, LLC; 452,036 shares owned via 7809-01 Kent, LLC; 263,844 shares owned via Workers for You; and 164,284 shares owned via Everyday Staffing East. |
3. The acquisition relates to shares owned indirectly that are now being converted to direct ownership as follows: 128,714 shares owned via Everyday Staffing, LLC; 100,441 shares owned via 7809-01 Kent, LLC; 58,625 shares owned via Workers for You; and 36,504 shares owned via Everyday Staffing East. |
4. Transfer from direct ownership to indirect ownership via spouse. |
5. Shares issued to acquire filers rights pursuant to a new office surcharge buyout agreement. |
6. Shares were issued directly by issuer to repay debt owed to shareholder. |
7. Gift to Hedgehog Management |
8. Gift to Enget Charitable Remainder Trust |
9. The disposition relates to shares owned indirectly that are now being converted to direct ownership. The disposition removes the shares from indirect ownership as follows: 311,347 shares owned via SW Temporary Development, LLC; 446,140 shares owned via Aardvark, LLC; and 119,080 shares owned via Valley Staffing Services of S Texas, LLC. |
10. The acquisition relates to shares owned indirectly that are now being converted to direct ownership as follows: 311,347 shares owned via SW Temporary Development, LLC; 446,140 shares owned via Aardvark, LLC; and 60,731 shares owned via Valley Staffing Services of S Texas, LLC. |
11. Indirect ownership via Welstad Supporting Organization transferred to indirect ownership via Welstad Family Foundation. |
12. The disposition relates to shares owned indirectly that are now being converted to direct ownership. The disposition removes the shares from indirect ownership as follows: 180,965 shares owned via ZMP Associates, LLC; and 434,686 shares owned via Harbor Bay Staffing Services, LLC. |
13. The acquisition relates to shares owned indirectly that are now being converted to direct ownership as follows: 120,643 shares owned via ZMP Associates, LLC; and 289,791 shares owned via Harbor Bay Staffing Services, LLC. |
14. Unit consists of one share of common stock and one-half of one common stock purchase warrant. Units acquired directly from issuer in private placement. |
15. This transaction converts indirect ownership into direct ownership. 168,946 shares owned indirectly via Sacramento Temporary Staffing Services, LLC were distributed among the members, resulting in direct ownership of 77,342 for this filer. |
16. Exercise price is $ 0.08, $ 0.16, $ 0.32, $ 0.50 and $ 1.00 until 4/15/11, 4/15/12, 4/15/13, 4/15/14 and 4/15/15, respectively. Unit consists of one share of common stock and one-half of one common stock purchase warrant. |
/s/ Glenn Welstad | 02/04/2011 | |
** 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. |