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*
ALTER IWONA

(Last) (First) (Middle)
9330 BALBOA AVENUE

(Street)
SAN DIEGO CA 92123

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/17/2016
3. Issuer Name and Ticker or Trading Symbol
JACK IN THE BOX INC /NEW/ [ JACK ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP - JIB CHIEF MKTNG OFFICER
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 2,814 D
COMMON STOCK 823(1) D
COMMON STOCK 1,054(2) 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
NON-QUALIFIED STOCK OPTION(3) 11/25/2015 11/25/2021 COMMON STOCK 1,556 $73.53 D
Explanation of Responses:
1. These securities represent the unvested portion of restricted stock unit grants made on 11/26/2013 and 11/25/2014. The grants of restricted stock units vest in three and five equal installments respectively commencing one year after the date of grant. A portion of RSU grants are subject to holding requirements.
2. These securities represent the unvested portion of a restricted stock unit grant made on 11/24/2015. The grant of restricted stock units vests in three equal installments commencing one year after the date of grant. This RSU grant is not subject to holding requirements.
3. These options become exercisable in three equal installments commencing one year after the date of grant.
Remarks:
IWONA ALTER 11/17/2016
** 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.
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.