-----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, ICLYz3zvmj8r8GlMeKWUMMNPyx5CgHvsYzHAKIzXRTZOqjWzlSxtAVqLM3ooyM4A vvIwC17snsJkWLxTUl7wIQ== /in/edgar/work/20000823/0000910643-00-000117/0000910643-00-000117.txt : 20000922 0000910643-00-000117.hdr.sgml : 20000922 ACCESSION NUMBER: 0000910643-00-000117 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000515 FILED AS OF DATE: 20000823 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: 3 SEC ACT: SEC FILE NUMBER: 001-15839 FILM NUMBER: 708159 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: POLE MICHAEL CENTRAL INDEX KEY: 0001121560 STANDARD INDUSTRIAL CLASSIFICATION: [7372 ]OFFICER STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 3 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 STREET 2: STE 1000 CITY: SANTA MONICA STATE: CA ZIP: 90405 3 1 0001.txt
FORM 3 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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* 2. Date of Event Re- 4. Issuer Name and Ticker or Trading quiring Statement Symbol Pole Michael (Month/Day/Year) Activision, Inc. (ATVI) (Last) (First) (Middle) 5/15/00 5. Relationship of Reporting Person 6. If Amendment, c/o Activision, Inc. to Issuer (Check all applicable) Date of Original 3100 Ocean Park Boulevard 3. IRS or Social (Month/Day/Year) (Street) Security Number of __ Director __ 10% Owner Reporting Person (Voluntary) X Officer (give __ Other (specify 7. Individual or Joint/ Santa Monica California 90405 title below) below) Group Filing (check (City) (State) (Zip) Applicable Line) Executive Vice President - X Form filed by One Worldwide Studios Reporting Person __ Form filed by More than One Reporting Person
Table 1 - Non-Derivative Securities Beneficially Owned 2. Amount of Securities 3. Ownership Form: Direct 4. Nature of Indirect Beneficial 1. Title of Security Beneficially Owned (D) or Indirect (I) Ownership (Instr. 5) (Instr. 4) (Instr. 4) (Instr. 5) Common Stock, par value $.000001 20,000 D(1) per share ("Common Stock") Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses)
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 1. Title of Derivative 2. Date Exercisable 3. Title and Amount of 4. Conversion or 5. Ownership 6. Nature of Security (Instr. 4) and Expiration Date Securities Underlying Exercise Price Form of Deri- Indirect - ----------------------- (Month/Day/Year) Derivative Security of Derivative vative Sec- Beneficial (Instr. 4) Security urity: Dir- Ownership --------------------- ---------------------- ect (D) or In (Instr. 4) Expira- Amount Direct (I) Date Exer- tion or Number (Instr. 4) cisable Date Title of Shares --------- ------- ------------- --------- -------------- -------------- --------------- Employee Stock Options 5/15/00 4/7/10 Common Stock 50,000 $8.00 D Employee Stock Options 5/1/01(2) 4/7/10 Common Stock 206,250 $8.00 D Employee Stock Options 5/1/01(3) 4/12/10 Common Stock 68,750 $6.50 D Explanation of Responses: (1) Includes 20,000 shares held by The Pole Family Trust of which the reporting person is a trustee. (2) The options vest 75,000 shares on 5/1/01; 75,000 shares on 5/1/02; and 56,250 shares on 5/1/03. (3) The options vest 25,000 shares on 5/1/01; 25,000 shares on 5/1/02; and 18,750 shares on 5/1/03. * Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Michael Pole 08/17/00 See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). --------------------------- ------------- **Signature of Reporting Person Date Michael Pole 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
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