SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
DOORNINK RONALD

(Last) (First) (Middle)
C/O ACTIVISION, INC.
3100 OCEAN PARK BOULEVARD

(Street)
SANTA MONICA CA 90405

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ACTIVISION INC /NY [ ATVI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
12/17/2007
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock, par value $0.00001 per share 10/01/2007 G(1) V 5,000(2) D $0 0 D
Common Stock, par value $0.00001 per share 10/01/2007 G(1) V 5,000(2) A $0 182,166(3) I See footnote(4)
Common Stock, par value $0.00001 per share 12/17/2007 M 750,000 A $6.998 932,166 I See footnote(4)
Common Stock, par value $0.00001 per share 12/17/2007 F 447,346(5) D $26.6 484,820 I See footnote(4)
Common Stock, par value $0.00001 per share 12/17/2007 M 600,000 A $6.998 1,084,820 I See footnote(4)
Common Stock, par value $0.00001 per share 12/17/2007 F 360,132(6) D $26.6 724,688 I See footnote(4)
Common Stock, par value $0.00001 per share 12/17/2007 M 247,413 A $6.998 972,101 I See footnote(4)
Common Stock, par value $0.00001 per share 12/17/2007 F 148,501(7) D $26.6 823,600(8) I See footnote(4)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Options $6.998 12/17/2007 M 750,000 12/12/2007 07/22/2012 Common Stock, par value $0.00001 per share 750,000 $0 0 I See footnote(4)
Employee Stock Options $6.998 12/17/2007 M 600,000 12/12/2007 07/22/2012 Common Stock, par value $0.00001 per share 600,000 $0 0 I See footnote(4)
Employee Stock Options $6.998 12/17/2007 M 247,413 12/12/2007 07/22/2012 Common Stock, par value $0.00001 per share 247,413 $0 0 I See footnote(4)
Explanation of Responses:
1. Reflects the transfer of restricted stock units from Mr. Doornink to the Ronald Doornink Martha Doornink TTEE U/A/D 12-17-1996 FBO Doornink Rev Living Trust.
2. Represents the previously reported grant of 5,000 restricted stock units, each representing the conditional right to receive one share of Activision common stock, that Mr. Doornink received on October 1, 2007.
3. Includes 177,166 shares of Activision common stock which were erroneously reported on the Form 4 Mr. Doornink filed on October 3, 2007 as being held by him directly but which were then, and are now, actually held indirectly in the name of the Ronald Doornink Martha Doornink TTEE U/A/D 12-17-1996 FBO Doornink Rev Living Trust, and that Form 4 is hereby amended to reflect indirect ownership of such shares.
4. These shares are held by the Ronald Doornink Martha Doornink TTEE U/A/D 12-17-1996 FBO Doornink Rev Living Trust.
5. On December 17, 2007, Mr. Doornink exercised options to purchase 750,000 shares of common stock and, pursuant to the terms of his option award, elected to surrender an aggregate of 447,346 shares to the Company to satisfy the exercise price for such options and the resulting withholding tax obligation.
6. On December 17, 2007, Mr. Doornink exercised options to purchase 600,000 shares of common stock and, pursuant to the terms of his option award, elected to surrender an aggregate of 360,132 shares to the Company to satisfy the exercise price for such options and the resulting withholding tax obligation.
7. On December 17, 2007, Mr. Doornink exercised options to purchase 247,413 shares of common stock and, pursuant to the terms of his option award, elected to surrender an aggregate of 148,501 shares to the Company to satisfy the exercise price for such options and the resulting withholding tax obligation.
8. Following the transactions reported on this Form 4, Mr. Doornink indirectly holds (a) 818,600 shares of Activision common stock and (b) 5,000 restricted stock units representing the conditional right to receive Activision common stock, all of which are held by the Ronald Doornink Martha Doornink TTEE U/A/D 12-17-1996 FBO Doornink Rev Living Trust
Remarks:
/s/ Ronald Doornink 12/19/2007
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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