0001592379-16-000175.txt : 20161201 0001592379-16-000175.hdr.sgml : 20161201 20161201131439 ACCESSION NUMBER: 0001592379-16-000175 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161129 FILED AS OF DATE: 20161201 DATE AS OF CHANGE: 20161201 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Papa Murphy's Holdings, Inc. CENTRAL INDEX KEY: 0001592379 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 272349094 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 8000 NE PARKWAY DRIVE STREET 2: SUITE 350 CITY: VANCOUVER STATE: WA ZIP: 98662 BUSINESS PHONE: 360 260-7272 MAIL ADDRESS: STREET 1: 8000 NE PARKWAY DRIVE STREET 2: SUITE 350 CITY: VANCOUVER STATE: WA ZIP: 98662 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tipp Jayson CENTRAL INDEX KEY: 0001606721 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36432 FILM NUMBER: 162027625 MAIL ADDRESS: STREET 1: C/O PAPA MURPHY'S HOLDINGS, INC. STREET 2: 8000 NE PARKWAY DRIVE, SUITE 350 CITY: VANCOUVER STATE: WA ZIP: 98662 4 1 wf-form4_148061606643501.xml FORM 4 X0306 4 2016-11-29 0 0001592379 Papa Murphy's Holdings, Inc. FRSH 0001606721 Tipp Jayson C/O PAPA MURPHY'S HOLDINGS, INC. 8000 NE PARKWAY DRIVE, SUITE 350 VANCOUVER WA 98662 0 1 0 0 SVP Tech & Chief Develop Off Common Stock, par value $0.01 per share 2016-11-29 4 P 0 4100 4.8398 A 34223 D Common Stock, par value $0.01 per share 10000 I By IRA Common Stock, par value $0.01 per share 910 I By children Shares are held by an IRA trust for the benefit of the Reporting Person. The reported securities are held in custodial account for the benefit of the Reporting Person's minor children. The Reporting Person disclaims beneficial ownership of these securities except to the extent of any pecuniary interest therein. /s/ Daniel R. Smith attorney-in-fact 2016-12-01