-----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, AtX5IXfLeuVj6beDyMIh7mDsW0nNEwGj789ZM1kyEZOMYbuhOHLWbO1j91cCCPR6 L43NT3snEQGyTetPN8sV3g== 0000897069-02-000459.txt : 20020614 0000897069-02-000459.hdr.sgml : 20020614 20020614155858 ACCESSION NUMBER: 0000897069-02-000459 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020614 FILED AS OF DATE: 20020614 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: HENNESSY ADVISORS INC CENTRAL INDEX KEY: 0001145255 STANDARD INDUSTRIAL CLASSIFICATION: INVESTMENT ADVICE [6282] FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 333-66970 FILM NUMBER: 02679576 BUSINESS ADDRESS: STREET 1: 750 GRANT AVENUE SUITE 100 CITY: NOVATO STATE: CA ZIP: 94945 MAIL ADDRESS: STREET 1: 750 GRANT AVENUE SUITE 100 CITY: NOVATO STATE: CA ZIP: 94945 COMPANY DATA: COMPANY CONFORMED NAME: NILSEN TERESA M CENTRAL INDEX KEY: 0001165098 OFFICER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: BUSINESS PHONE: 4158991555 MAIL ADDRESS: STREET 1: 750 GRANT AVENUE STREET 2: SUITE 100 CITY: NOVATO STATE: CA ZIP: 94945 3 1 dkm87.txt FORM 3 FOR TERESA NILSEN ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0104 Expires: January 31, 2005 Estimated average burden hours per response ....... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 ________________________________________________________________________________ 1. Name and Address of Reporting Person* Nilsen Teresa M. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 750 Grant Avenue, Suite 100 - -------------------------------------------------------------------------------- (Street) Novato CA 94945 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Date of Event Requiring Statement (Month/Day/Year) June 17, 2002* *anticipated effective date of Hennessy Advisors, Inc. Form 8-A ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Issuer Name and Ticker or Trading Symbol Hennessy Advisors, Inc. ________________________________________________________________________________ 5. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [_] 10% Owner [X] Officer (give title below) [_] Other (specify below) Executive Vice President and Secretary -------------------------------------- ________________________________________________________________________________ 6. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 7. 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 ================================================================================
3. Ownership Form: 2. Amount of Securities Direct (D) or 1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, no par value 20,100 D - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, no par value 100 I FBO Son - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, no par value 100 I FBO Son - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Form 3-07/98) FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
5. Owner- 3. Title and Amount of Securities ship Underlying Derivative Security Form of 2. Date Exercisable (Instr. 4) Derivative and Expiration Date --------------------------------- 4. Conver- Security: (Month/Day/Year) Amount sion or Direct 6. Nature of ---------------------- or Exercise (D) or Indirect Date Expira- Number Price of Indirect Beneficial 1. Title of Derivative Exer- tion of Derivative (I) Ownership Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Stock Option (right to acquire) 2/28/02 2/28/12 Common Stock 7,500 $10.00 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: /s/ Linda Y. Kelso June 13, 2002 - ----------------------------------------- ----------------------- Linda Y. Kelso, as attorney-in-fact for Teresa M. Nilsen ** 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 provided is insufficient, see Instruction 6 for procedure. EXHIBIT A POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, that the undersigned, whose signature appears below, constitutes and appoints Neil J. Hennessy and Linda Y. Kelso, and each or either of them, as such person's true and lawful attorney-in-fact and agent, with full power of substitution and resubstitution, for such person in his/her name, place and stead, in any and all capacities, to sign the undersigned's Form 3 and any and all Forms 4 or 5 (and any amendments to any of the foregoing) relating to the securities of Hennessy Advisors, Inc. required to be filed with the Securities and Exchange Commission by the undersigned for the period beginning from the date hereof through December 31, 2003, as such forms may be promulgated from time to time under Section 16 of the Securities Exchange Act of 1934, as amended, and to file the same with the Securities and Exchange Commission, granting unto said attorney-in-fact and agent full power and authority to do and perform each and every act and thing requisite and necessary to be done in and about the premises, as fully to all intents and purposes as he/she might or could do in person, hereby ratifying and confirming all that said attorneys-in-fact and agents or his or her substitute may lawfully do or cause to be done by virtue hereof. IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney as of the 24th day of January, 2002. /s/ Teresa M. Nilsen --------------------------------------- Teresa M. Nilsen -----END PRIVACY-ENHANCED MESSAGE-----