Statement of Changes in Beneficial Ownership (4)
November 30 2017 - 1:19PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Fisher Cynthia A
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2. Issuer Name
and
Ticker or Trading Symbol
BOSTON BEER CO INC
[
SAM
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
186 PARK STREET
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3. Date of Earliest Transaction
(MM/DD/YYYY)
11/28/2017
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(Street)
NEWTON, MA 02458
(City)
(State)
(Zip)
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4. 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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Class A Common
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11/28/2017
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G
(1)
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V
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21000.00
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A
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$0.00
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23000.00
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I
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By Foundation managed by Reporting Person's Spouse
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Class A Common
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44248.00
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I
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By LLC managed by Reporting Person
(2)
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Class A Common
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27437.00
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I
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By LLC managed by Reporting Person
(3)
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Class A Common
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23486.00
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I
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By spouse as custodian for children under UGTMA
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Class A Common
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3656.00
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I
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Custodian for children under UGTMA
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Class A Common
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2532.00
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I
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As trustee in trust for children
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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. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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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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Explanation of Responses:
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(1)
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This transaction is a Form 5 transaction being voluntarily reported early. On the Transaction Date, the Reporting Person's spouse gifted 21,000 shares from his direct ownership into a foundation that the Reporting Person's spouse controls. The Reporting Person serves on the Board of Directors of the foundation, but disclaims beneficial ownership of the shares.
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(2)
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The shares are held by an LLC managed by the Reporting Person and owned by Trusts established for the benefit of the Reporting Person's children and the Reporting Person's spouse's children. The Reporting Person is the Trustee or Co-Trustee for each Trust.
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(3)
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The shares are held by West Summit Grand LLC, a limited liability company managed by the Reporting Person. The Reporting Person expressly disclaims beneficial ownership of the securities except to the extent of her pecuniary interest therein.
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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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Fisher Cynthia A
186 PARK STREET
NEWTON, MA 02458
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X
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Signatures
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Michael G. Andrews under POA for the benefit of Cynthia A. Fisher
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11/30/2017
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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 4(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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