-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, DHKwWw9b62YZtXS9XB7U4+cvk8qrCA1KNZ+yxENMq48nUEW77Yhg5pSDJIiGMfya oCBYVGSBBzCNbRvqZRr4ww== 0001005477-00-000412.txt : 20000203 0001005477-00-000412.hdr.sgml : 20000203 ACCESSION NUMBER: 0001005477-00-000412 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20000201 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: JACKPOT ENTERPRISES INC CENTRAL INDEX KEY: 0000351903 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISCELLANEOUS AMUSEMENT & RECREATION [7990] IRS NUMBER: 880169922 STATE OF INCORPORATION: NV FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: SC 13G SEC ACT: SEC FILE NUMBER: 005-33496 FILM NUMBER: 519068 BUSINESS ADDRESS: STREET 1: 1110 PALMS AIRPORT DR CITY: LAS VEGAS STATE: NV ZIP: 89119 BUSINESS PHONE: 7022635555 MAIL ADDRESS: STREET 1: 1110 PALMS AIRPORT DRIVE STREET 2: 1110 PALMS AIRPORT DRIVE CITY: LAS VEGAS STATE: NV ZIP: 89119 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: JOURDEN ROGER DAVID CENTRAL INDEX KEY: 0001104308 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 4750 WHITEHALL ROAD CITY: MUSKEGON STATE: MI ZIP: 49445 BUSINESS PHONE: 2317663377 SC 13G 1 SCHEDULE 13G SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ---------- SCHEDULE 13G (Rule 13d-102) INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULE 13d-1(b)(c), AND (d) AND AMENDMENTS THERETO FILED PURSUANT TO RULE 13d-2(b) (Amendment No. __)(1) Jackpot Enterprises, Inc. - -------------------------------------------------------------------------------- (Name of Issuer) Class A Common - -------------------------------------------------------------------------------- (Title of Class of Securities) 4666392107 - -------------------------------------------------------------------------------- (CUSIP Number) September 27, 1999 - -------------------------------------------------------------------------------- (Date of Event which Requires Filing of this Statement) Check the appropriate box to designate the rule pursuant to which this Schedule is filed: |_| Rule 13d-1 (b) |X| Rule 13d-1 (c) |_| Rule 13d-1 (d) - ---------- (1) The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page. The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). CUSIP No. 466392107 SCHEDULE 13G Page 2 of 5 Pages - -------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) Roger David Jourden and Mary Lynn Jourden - -------------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) |_| (b) |_| - -------------------------------------------------------------------------------- 3 SEC USE ONLY - -------------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION United States - -------------------------------------------------------------------------------- 5 SOLE VOTING POWER 777,300 -------------------------------------------------------------- NUMBER OF 6 SHARED VOTING POWER SHARES BENEFICIALLY 127,900 OWNED BY -------------------------------------------------------------- EACH 7 SOLE DISPOSITIVE POWER REPORTING PERSON 777,300 WITH -------------------------------------------------------------- 8 SHARED DISPOSITIVE POWER 127,900 - -------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 905,200 - -------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* - -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 10.5% - -------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* Individuals (husband and wife) - -------------------------------------------------------------------------------- *SEE INSTRUCTIONS BEFORE FILLING OUT! Item 1(a). Name of Issuer: Jackpot Enterprises, Inc. --------------------------------------------------------------- Item 1(b). Address of Issuer's Principal Executive Offices: 1110 Palms Airport Dr., Las Vegas, Nevada 89119 --------------------------------------------------------------- Item 2(a). Name of Person Filing Roger David Jourden and Mary Lynn Jourden --------------------------------------------------------------- Item 2(b). Address of Principal Business Office or, if None, Residence: 4750 Whitehall Rd., Muskegon, MI 49445 --------------------------------------------------------------- Item 2(c). Citizenship United States --------------------------------------------------------------- Item 2(d). Title of Class of Securities: Class A Common Item 2(e). CUSIP Number 466392107 Item 3. If This Statement is Filed Pursuant to Rule 13d-1(b), or 13d-2(b) or (c), Check Whether the Person Filing is a: (a) |_| Broker or dealer registered under Section 15 of the Exchange Act. (b) |_| Bank as defined in Section 3(a)(6) of the Exchange Act. (c) |_| Insurance company as defined in Section 3(a)(19) of the Exchange Act. (d) |_| Investment company registered under Section 8 of the Investment Company Act. (e) |_| An investment adviser in accordance with Rule 13d-1(b)(1)(ii)(E); (f) |_| An employee benefit plan or endowment fund in accordance with Rule 13d-1(b)(1)(ii)(F); (g) |_| A parent holding company or control person in accordance with Rule 13d-1(b)(1)(ii)(G); (h) |_| A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act; (i) |_| A church plan that is excluded from the definition of an investment company under Section 3(c)(14) of the Investment Company Act; (j) |_| Group, in accordance with Rule 13d-1(b)(1)(ii)(J). Item 4. Ownership. Provide the following information regarding the aggregate nubmer and percentage of the class of securities of the issuer identified in Item 1. (a) Amount beneficially owned: 905,200 ---------------------------------------------------------------- (b) Percent of class: 10.5% ---------------------------------------------------------------- (c) Number of shares as to which such person has: (i) Sole power to vote or to direct the vote 777,300 ----------------------- (ii) Shared power to vote or to direct the vote 127,900 -------------------- (iii) Shared power to dispose or to direct the disposition of 773,000 -------------------------------------------------------------- (iv) Shared power to dispose or to direct the disposition of 127,900 --------------------------------------------------------------- Item 5. Ownership of Five Percent or Less of a Class. If this statement in being flied to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of Securities, check the following |_|. Item 6. Ownership of More than Five Percent on Behalf of Another Person. Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company. Item 8. Identification and Classification of Members of the Group. Item 9. Notice of Dissolution of Group. Item 10. Certifications. (a) The following certification shall be included if the statement is filed pursuant to Rule 13d-1(b); (b) The following certification shall be included if the statement is filed pursuant to Rule 13d-1(c); "By signing below I certify that to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect." SIGNATURE After reasonable inquiry and to the best of my knowledge and belief; I certify that the information set forth in this statement is true, complete and correct. 1-3-00 1-3-00 - ------------------------------------- ------------------------------------- (Date) (Date) /s/ Roger David Jourden /s/ Mary Lynn Jourden - ------------------------------------- ------------------------------------- (Signature) (Signature) Roger David Jourden Mary Lynn Jourden - ------------------------------------- ------------------------------------- (Name/Title) (Name/Title) -----END PRIVACY-ENHANCED MESSAGE-----