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*
Bloss Roger James

(Last) (First) (Middle)
201 W NORTH RIVER DR. #100

(Street)
SPOKANE WA 99201

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Red Lion Hotels CORP [ RLH ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
E.V.P. & President Global Devp
3. Date of Earliest Transaction (Month/Day/Year)
01/19/2018
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 01/31/2018 A 414,000(1) A $8.34(2) 1,104,000 I By Corporation(3)
Common Stock 48,277(4) D
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. On January 19, 2018, Thirty-Eight Street, Inc. ("TESI") of which the reporting person is the President and Chief Executive Officer and holds 50% of the outstanding shares, became entitled to receive 414,000 shares of RLH common stock pursuant to an Asset Purchase Agreement dated September 30, 2016 between RLH, Vantage Hospitality Group, Inc., and TESI. The asset purchase agreement provided TESI would become eligible to earn an additional 414,000 shares of RLH common stock, for no additional consideration, upon the attainment of certain performance criteria, specifically the retention of Vantage properties under franchise or membership license agreements during the 12 months ended September 30, 2017. The reporting person's right to receive additional shares became fixed and irrevocable on September 30, 2016, the effective date of the Vantage acquisition.
2. The price is based on the closing price on September 30, 2016, the date of the Vantage acquisition.
3. Represents shares held by Thirty-Eight Street, Inc. a Florida corporation ("TESI"). Mr. Bloss disclaims beneficial ownership of the portion of these shares in which he does not have any pecuniary interest. Mr. Bloss hold 50% of the outstanding shares of TESI and serves as its President and Chief Executive Officer.
4. Amount includes total number of restricted stock units held.
Remarks:
/s/Julie Langenheim, Attorney-in-fact 02/02/2018
** 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).
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