-----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, LvtkrIwmRtLPZFZyDEjNWpsW3gq/1xfqnSxn5yNCSZesEF2ANEPE+YSIJvIMWRZw +ELWYAXzLEgV8NshemTLrA== 0000910643-00-000074.txt : 20000503 0000910643-00-000074.hdr.sgml : 20000503 ACCESSION NUMBER: 0000910643-00-000074 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000331 FILED AS OF DATE: 20000502 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ACTIVISION INC /NY CENTRAL INDEX KEY: 0000718877 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 942606438 STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 001-15839 FILM NUMBER: 616530 BUSINESS ADDRESS: STREET 1: 3100 OCEAN PARK BLVD STREET 2: STE 1000 CITY: SANTA MONICA STATE: CA ZIP: 90405 BUSINESS PHONE: 3102552000 MAIL ADDRESS: STREET 1: 11601 WILSHIRE BLVD 3RD FL STREET 2: STE 1000 CITY: LOS ANGELES STATE: CA ZIP: 90025 FORMER COMPANY: FORMER CONFORMED NAME: MEDIAGENIC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: ACTIVISION INC DATE OF NAME CHANGE: 19880829 COMPANY DATA: COMPANY CONFORMED NAME: KOTICK ROBERT A CENTRAL INDEX KEY: 0001091423 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] DIRECTOR STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 3100 OCEAN PARK BLVD STREET 2: STE 1000 CITY: SANTA MONICA STATE: CA ZIP: 90405 BUSINESS PHONE: 3102552000 MAIL ADDRESS: STREET 1: 3100 OCEAN PARK BLVD CITY: SANTA MONICA STATE: CA ZIP: 90405 5 1
U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 [ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). [ ] Form 3 Holdings Reported [ ] Form 4 Transactions Reported. 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Issuer (Check all applicable) Kotick Robert A. Activision, Inc. (ATVI) __________________________________________ _____________________________________________ X Director 10% Owner --- --- (Last) (First) (Middle) 3. IRS or Social 4. Statement for X Officer (give Other (Specify Security Number of Month/Year --- title below) --- below) c/o Activision, Inc. Reporting Person 3100 Ocean Park Boulevard (Voluntary) March 31, 2000 Chairman and Chief Executive Officer __________________________________________ ______________________________________________________________ (Street) 5. If Amendment, Date of 7. Individual or Joint/Group Filing Santa Monica California 90405 Original (Month/Year) (Check applicable line) __________________________________________ _X_ Form Filed by one Reporting Person (City) (State) (Zip) Form Filed by more than one --- Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 5. Amount of Securi- ties Bene- ficially 4. Securities Acquired (A) Owned at 6. Ownership 2. Trans- 3. Trans- or Disposed of (D) End of Form: action action (Instr. 3, 4 and 5) Issuer's Direct 7. Nature of Date Code --------------------------- Fiscal (D) or Indirect Month/ (Instr. 8) (A) Year Indirect Beneficial 1. Title of Security Day/ Amount or Price (Instr. (I) Ownership (Instr.3) Year) (D) 3 and 4) (Instr. 4) (Instr. 4) - ----------------------------- --------- ---------- -------- --- -------- ------------ ------------- ------------- Common Stock, par value $.000001 per share 803,729 D Common Stock, par value $.000001 per share 56,981 I (1) * If the form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly of indirectly. (Print or Type Responses)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 2. Conver- 5. Number of Deriv- 6. Date Exercisable sion or 3. Trans- ative Securities and Expiration Date Exercise action Acquired (A) or (Month/Day/Year) Price of Date 4. Trans- Disposed of (D) ----------------------- Deriv- (Month/ action (Instr. 3, 4, and 5) Date 1. Title of Derivative Security ative Day/ Code ----------------------- Exercis- Expiration (Instr. 3) Security Year) (Instr. 8) A D able Date - ---------------------------------- ----------- ---------- ------------ ----------- ----------- ---------- ---------- Employee Stock Option $10.25 4/30/99 A 137,634 4/30/99 4/30/09 Employee Stock Option $10.25 4/30/99 A 21,875 4/30/99 4/30/09
9. Number of 10. Ownership Derivative Form of 7. Title and Amount of Underlying Securities Derivative Securities (Instr. 3 and 4) Beneficially Security: 11. Nature of --------------------------------- 8. Price of Owned Direct (D) Indirect Amount or Derivative at End or Beneficial 1. Title of Derivative Title Number of Security of Year Indirect (I) Ownership Security (Instr. 3) Shares (Instr. 5) (Instr. 4) (Instr. 4) (Instr. 4) - ---------------------- -------------------- --------- ------------- ------------- -------------- -------------- Employee Stock Option Common Stock 137,634 Employee Stock Option Common Stock 21,875 2,483,373 D Explanation of Responses: (1) Includes 19,500 shares held in an irrevocable trust for the benefit of reporting person's minor children. Mr. Kotick does not exercise or share investment control over such shares. Also includes 37,481 shares held by Delmonte Investments LLC, of which the reporting person is a member. The reporting person disclaims beneficial ownership of these shares, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such shares for purposes of Section 16 or for any other purpose. /s/ Robert A. Kotick 4/28/00 **Intentional misstatements or omissions of facts constitute ------------------------------- -------------- Federal Criminal Violations. See 18 U.S.C. 1001 and **Signature of Reporting Person Date 15 U.S.C. 78ff(a). Robert A. Kotick Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Page 2 SEC 1474 (8-92)
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