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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Wolszczak Jay Anthony

(Last) (First) (Middle)
C/O FIRST WATCH RESTAURANT GROUP, INC.
8725 PENDERY PLACE, SUITE 201

(Street)
BRADENTON FL 34201

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/01/2021
3. Issuer Name and Ticker or Trading Symbol
First Watch Restaurant Group, Inc. [ FWRG ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
General Counsel and Secretary
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)
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
Stock Option (right to buy) (1) 07/18/2028 Common stock 177,570(1) $8.45 D
Stock Option (right to buy) (2) 04/24/2029 Common stock 69,055(2) $12.68 D
Explanation of Responses:
1. Represents stock options awarded on July 18, 2018, pursuant to the Issuer's 2017 Omnibus Equity Incentive Plan (the "Plan"). Unvested stock options vest in installments as follows: (a) 21,308 options on each of July 18, 2022 and the first anniversary thereof; and (b) 23,676 options on each of the first two anniversaries of the closing of the Issuer's initial public offering (the "IPO") and on the 273rd day following the second anniversary of the closing of the IPO, subject to earlier forfeiture or acceleration.
2. Represents stock options awarded on April 24, 2019, pursuant to the Plan. Unvested stock options vest in installments as follows: (a) 8,286 options on April 24, 2022, and 8,287 options on each of the first two anniversaries thereof; and (b) 9,207 options on each of the first two anniversaries of the closing of the IPO, and 9,208 options on the 273rd day following the second anniversary of the closing of the IPO, subject to earlier forfeiture or acceleration.
Remarks:
Exhibit 24 - Power of Attorney, incorporated herein by reference
By: /s/ Jay Wolszczak 10/01/2021
** 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.