SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
ROSE GEORGE L

(Last) (First) (Middle)
C/O BRYAN COVE LLP
1290 AVENUE OF THE AMERICAS

(Street)
NEW YORK NY 10104-3300

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ACTIVISION INC /NY [ ATVI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Sr. Vice Pres & Gen. Counsel
3. Date of Earliest Transaction (Month/Day/Year)
02/09/2005
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock, par value $.000001 per share 02/09/2005 M 20,500 A $8 20,500 D
Common Stock, par value $.000001 per share 02/09/2005 M 12,378 A $6.0089 32,878 D
Common Stock, par value $.000001 per share 02/09/2005 M 40,500 A $6.1852 73,378 D
Common Stock, par value $.000001 per share 02/09/2005 S 73,378 D $23.06 0 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Options $8 02/09/2005 M 20,500 (1) 11/20/2002 Common Stock 20,500 $0 69,500 D
Employee Stock Option $6.0089 02/09/2005 M 12,378 (2) 04/11/2013 Common Stock 12,378 $0 17,322 D
Employee Stock Options $6.1852 02/09/2005 M 40,500 (3) 04/04/2011 Common Stock 40,500 $0 0 D
Explanation of Responses:
1. 45,000 of the options have vested. The balance will vest in two equal annual installments on 11/20/05 and 11/20/06.
2. One half of the option vests in three equal annual installments beginning on April 1, 2004. The second half of the option will vest on April 1, 2009, however, the second half of the option may vest on an accelerated basis if certain earning and other financial goals are met.
3. The options vested in four equal installments on each of 10/1/00, 4/1/01, 10/1/01 and 4/1/02.
/s/ George L. Rose 02/11/2005
** 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 4 (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.