Initial Statement of Beneficial Ownership (3)
August 17 2017 - 4:31PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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BRINK JOSEPH
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2. Date of Event Requiring Statement (MM/DD/YYYY)
8/9/2017
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3. Issuer Name
and
Ticker or Trading Symbol
Fiesta Restaurant Group, Inc. [FRGI]
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(Last)
(First)
(Middle)
C/O FIESTA RESTAURANT GROUP, INC., 14800 LANDMARK BOULEVARD
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
VP, Chief Procurement Officer /
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(Street)
DALLAS, TX 75254
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock, $0.01 par value
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17091
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Performance Rights
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(1)
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(1)
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Common Stock
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2410
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(1)
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D
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Explanation of Responses:
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(1)
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Each performance right represents a contingent right to receive one share of the Issuer's common stock. The performance rights vest on March 6, 2020 upon (i) the Issuer's common stock achieving an average closing market price at or above $25.00 for the last 20 trading days of the performance period with March 6, 2018 as the last day of the performance period and (ii) the employment of the Reporting Person by the Issuer on March 6, 2020.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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BRINK JOSEPH
C/O FIESTA RESTAURANT GROUP, INC.
14800 LANDMARK BOULEVARD
DALLAS, TX 75254
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VP, Chief Procurement Officer
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Signatures
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/s/ Joseph W. Brink
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8/17/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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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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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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 control number.
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