-----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, JJKMhwRzGvd6VH6FMRYSfbrUN7HNku+e27b0Aq/162hhF9sYgyysJEDYRsXB9H06 U4+bnchopP/inh42zNWW1Q== 0000950138-05-000122.txt : 20050211 0000950138-05-000122.hdr.sgml : 20050211 20050211185603 ACCESSION NUMBER: 0000950138-05-000122 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050209 FILED AS OF DATE: 20050211 DATE AS OF CHANGE: 20050211 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ACTIVISION INC /NY CENTRAL INDEX KEY: 0000718877 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 954803544 STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KOTICK ROBERT A CENTRAL INDEX KEY: 0001091423 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15839 FILM NUMBER: 05601213 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 feb9kotick-4_ex.xml X0202 4 2005-02-09 0 0000718877 ACTIVISION INC /NY ATVI 0001091423 KOTICK ROBERT A C/O ACTIVISON, INC. 3100 OCEAN PARK BOULEVARD SANTA MONICA CA 90405 1 1 0 0 Chairman & Chief Exec Officer Common Stock, par value $.000001 per share 2005-02-09 4 M 0 462378 4.0178 A 462378 I See Common Stock, par value $.000001 per share 2005-02-09 4 M 0 5625 3.8519 A 468003 I See Common Stock, par value $.000001 per share 2005-02-09 4 M 0 619878 5.0193 A 1087881 I See Common Stock, par value $.000001 per share 2005-02-09 4 M 0 619874 6.2756 A 1707755 I See Common Stock, par value $.000001 per share 2005-02-09 4 S 0 1707755 23.06 D 0 I See Common Stock, par value $.000001 per share 2005-02-09 4 M 0 840807 1.8148 A 840807 I See Common Stock, par value $.000001 per share 2005-02-09 4 S 0 840807 23.06 D 0 I See Employee Stock Options 4.0178 2005-02-09 4 M 0 462378 0 D 1995-07-21 2005-07-21 Common Stock 462378 0 I See Employee Stock Options 3.8519 2005-02-09 4 M 0 5625 0 D 1996-04-01 2006-04-01 Common Stock 5625 0 I See Employee Stock Options 5.0193 2005-02-09 4 M 0 619878 0 D 1995-07-21 2005-07-21 Common Stock 619878 0 I See Employee Stock Options 6.2756 2005-02-09 4 M 0 619874 0 D 1995-07-21 2005-07-21 Common Stock 619874 0 I See Employee Stock Options 1.8148 2005-02-09 4 M 0 840807 0 D 2000-05-22 2010-05-22 Common Stock 840807 0 I See Represents Common Stock acquired/disposed by KAG Holdings LLC, of which the reporting person is a member. Reporting Person is the direct beneficial owner of 2,859,684 shares of Common Stock and is an indirect beneficial owner of 63,249 shares of Common Stock by virtue of his being a member of Delmonte Investments LLC. Represents Common Stock acquired/disposed by 45121G Trust, in which the reporting person has a pecuniary interest. Exercise of options to purchase Common Stock by KAG Holdings LLC, of which the reporting person is a member. These options were originally issued to the reporting person and subsequently transferred to KAG Holdings LLC, and therefore the form of ownership of these options changed from direct to indirect. In accordance with Rule 16a-13, changes in the form of ownership are not required to be reported in a Form 4 or Form 5. Exercise of options to purchase Common Stock by 45121G Trust, in which the reporting person has a pecuniary interest. These options were held by 1011 Partners, LLC and subsequently transferred to the Reporting Person, who subsequently transferred them to 45121G Trust, and therefore the form of ownership of these options changed from indirect to direct to indirect. In accordance with Rule 16a-13, changes in the form of ownership are not required to be reported in a Form 4 or Form 5. Acquisition/Disposition of shares by KAG Holdings LLC, of which the reporting person is a member. Acquisition/Disposition of shares by 45121G Trust, in which the reporting person has a pecuniary interest. Represents options to buy Common Stock held by KAG Holdings LLC, of which the reporting person is a member. Represents options to buy Common Stock held by 45121G Trust, in which the reporting person has a pecuniary interest. George Rose was granted a power of attorney to sign all Forms 4 and Forms 5 on behalf of Mr. Kotick. /s/ George L. Rose (as Attorney-In-Fact) 2005-02-11 -----END PRIVACY-ENHANCED MESSAGE-----