-----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, KaGNi1S3HjJtVIq1DPx+OQQBtx1qyp57pn1yjp0+AOgvGhx+shMb2WWfPyMdOWsL dv8SrlHrvYdede2kBqsh0A== /in/edgar/work/20000809/0000910643-00-000108/0000910643-00-000108.txt : 20000921 0000910643-00-000108.hdr.sgml : 20000921 ACCESSION NUMBER: 0000910643-00-000108 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000731 FILED AS OF DATE: 20000809 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ACTIVISION INC /NY CENTRAL INDEX KEY: 0000718877 STANDARD INDUSTRIAL CLASSIFICATION: [7372 ] IRS NUMBER: 942606438 STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 001-15839 FILM NUMBER: 689049 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: [7372 ]OFFICER STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 4 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 4 1 0001.txt
U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 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 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 Chairman of the Board and Chief 3100 Ocean Park Boulevard (Voluntary) July 2000 Executive Officer ______________________________________________________________ __________________________________________ (Street) 5. If Amendment, Date of 7. Individual or Joint/Group Filing Original (Month/Year) (Check Applicable Line) Santa Monica California 90405 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 3. Trans- 4. Securities Acquired (A) Securities 2. Trans- action or Disposed of (D) Beneficially 6. Ownership action Code (Instr. 3, 4 and 5) Owned at Form: 7. Nature of Date (Instr. --------------------------- End of Direct(D) Indirect (Month/ 8) (A) Month or Beneficial 1. Title of Security Day/ Amount or Price (Instr. Indirect(I) Ownership (Instr.3) Year) (D) 3 and 4) (Instr. 4) (Instr. 4) - ----------------------------- --------- ---------- -------- --- -------- ------------ ------------- ------------ Common Stock, par value $.000001 per share 899,811 D 86,981 I (1) * If this 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 or 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- 4. Trans- ative Securities and Expiration Date Exercise action action Acquired (A) or (Month/Day/Year) Price of Date Code Disposed of (D) ----------------------- Deriv- (Month/ (Instr. 8) (Instr. 3, 4, and 5) Date 1. Title of Derivative Security ative Day/ ----- ---- ----------------------- Exercis- Expiration (Instr. 3) Security Year) Code V (A) (D) able Date - ---------------------------------- ----------- ---------- ------------ ----------- ----------- ---------- ---------- Employee Stock Options $10.50 7/6/00 G 100,000 3/23/00 3/23/09 Employee Stock Options $10.50 7/6/00 G 100,000 3/23/00 3/23/09 9. Number of 10. Ownership Derivative Form of Securities Derivative 7. Title and Amount of Underlying Benefi- Security: Securities (Instr. 3 and 4) cially Direct 11. Nature of --------------------------------- 8. Price of Owned (D) or Indirect Amount or Derivative at End Indirect Beneficial 1. Title of Derivative Title Number of Security of Month (I) Ownership Security (Instr. 3) Shares (Instr. 5) (Instr. 4) (Instr. 4) (Instr. 4) - ---------------------- -------------------- --------- ------------- ------------- -------------- -------------- Employee Stock Options Common Stock 100,000 Employee Stock Options Common Stock 100,000 2,276,602 D 110,689 I By Trust (2) Explanation of Responses: (1) Includes 49,500 shares held in an irrevocable trust for the benefit of the 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. Mr. Kotick disclaims beneficial ownership of all such 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. (2) Represents 110,689 options transferred by the reporting person to an irrevocable trust for the benefit of reporting person's minor children. The reporting person disclaims beneficial ownership of all such options and the shares of common stock underlying such options, and this report shall not be deemed an admission that the reporting person is the beneficial owner of such options or the shares of Common Stock underlying such options for purposes of Section 16 or for any other purpose. /s/ Robert A. Kotick 08/08/00 **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.
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