-----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, RR0VPJQ/Vl5oiYTPBCFONjKWFmO7ozTqoeaGUdcLJK0flOGmUgbGo+OF5kzI3YSd shmYPVMw4r9UTWNHDjLVVg== 0000910643-99-000125.txt : 19990817 0000910643-99-000125.hdr.sgml : 19990817 ACCESSION NUMBER: 0000910643-99-000125 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990809 FILED AS OF DATE: 19990816 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: 3 SEC ACT: SEC FILE NUMBER: 000-12699 FILM NUMBER: 99691048 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: VRABECK KATHY P CENTRAL INDEX KEY: 0001093166 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [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: ACTIVISION INC STREET 2: 3100 OCEAN PARK BLVD CITY: SANTA MONICA STATE: CA ZIP: 90405 3 1
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 Vrabeck Kathy P. (Month/Day/Year) Activision, Inc. (ATVI) (Last) (First) (Middle) 8/9/99 5. Relationship of Reporting Persons 6. If Amendment, Activision, Inc. to Issuer (Check all applicable) Date of Original 3100 Ocean Park Boulevard 3. I.R.S. Identification (Month/Day/Year) (Street) Number of Reporing __ Director __ 10% Owner Person, if an entity (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 Global Brand Management Reporting Person __ Form filed by More than One Reporting Person
Table 1 - Non-Derivative Securities Beneficially Owned 1. Title of Security 2. Amount of Securities 3. Ownership Form: Direct 4. Nature of Indirect Beneficial (Instr. 4) Beneficially Owned (D) or Indirect (I) Ownership (Instr. 4) (Instr. 4) (Instr. 4) 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 --------- ------- ------------- --------- -------------- -------------- --------------- Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Kathy P. Vrabeck 8/12/99 See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). --------------------------- ------------- **Signature of Reporting Person Date Kathy P. Vrabeck 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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