-----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, Lyo2t8e7BThIx23fU4KZcwZAjPWQIVyOtkwZAn95oc4cKF127ZN/Shjv67/sDDVL UGw30M3H2b7J1GXc4e7Q1Q== 0000932893-02-000002.txt : 20021004 0000932893-02-000002.hdr.sgml : 20021004 20021004103018 ACCESSION NUMBER: 0000932893-02-000002 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020925 FILED AS OF DATE: 20021004 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CHAMPPS ENTERTAINMENT INC/ MA CENTRAL INDEX KEY: 0001040328 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING & DRINKING PLACES [5810] IRS NUMBER: 043370491 STATE OF INCORPORATION: DE FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-22639 FILM NUMBER: 02781594 BUSINESS ADDRESS: STREET 1: 5619 DTC PARKWAY STREET 2: SUITE 1000 CITY: ENGLEWOOD STATE: CO ZIP: 80111 BUSINESS PHONE: 3038041333 MAIL ADDRESS: STREET 1: 5619 DTC PARKWAY STREET 2: SUITE 1000 CITY: ENGLEWOOD STATE: CO ZIP: 80111 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: ODONNELL MICHAEL P CENTRAL INDEX KEY: 0000932893 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 288 DEER RUN DRIVE CITY: VERDA BEACH STATE: FL ZIP: 32082 BUSINESS PHONE: 5617621345 MAIL ADDRESS: STREET 1: 288 DEER RUN DRIVE CITY: VER BEACH STATE: FL ZIP: 32082 3 1 odonnell021001.txt MICHAEL P. O'DONNEL'S FORM 3 DATED 10/4/02 ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0104 Expires: January 31, 2005 Estimated average burden hours per response.........0.5 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 3 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(h) of the Investment Company Act of 1940 (Print of Type Responses) - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* O'Donnell Michael P. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 288 Deer Run Drive - -------------------------------------------------------------------------------- (Street) Ponte Vedra Beach Florida 32082 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Date of Event Requiring Statement (Month/Day/Year) 9/25/02 - -------------------------------------------------------------------------------- 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) - -------------------------------------------------------------------------------- 4. Issuer Name and Ticker or Trading Symbol Champps Entertainment, Inc. (CMPP) - -------------------------------------------------------------------------------- 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) |X| Director |_| 10% Owner |_| Officer (give title below) |_| Other (specify below) -------------------------------------------------------------------- - -------------------------------------------------------------------------------- 6. If Amendment, Date of Original (Month/Day/Year) - -------------------------------------------------------------------------------- 7. 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 Beneficially Owned ================================================================================
3. Ownership Form: 2. Amount of Securities Direct (D) or 1. Title of Security Beneficially Owned Indirect (I) 4. Nature of Indirect Beneficial Ownership (Instr. 4) (Instr. 4) (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
5. Owner- 3. Title and Amount of Securities ship Underlying Derivative Security Form of 2. Date Exercisable (Instr. 4) Derivative and Expiration Date --------------------------------- 4. Conver- Securities: (Month/Day/Year) Amount sion or Direct 6. Nature of ---------------------- or Exercise (D) or Indirect Date Expira- Number Price of Indirect Beneficial 1. Title of Derivative Exer- tion of Derivative (I) Ownership Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Options to Purchase Common Stock 9/25/03 9/25/12 Common Stock 10,000 8.58 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Explanation of Responses: /s/ Michael P. O'Donnell 10/4/02 - --------------------------------------------- ----------------------- **Signature of Reporting Person Date * If the form is filed by more than one reporting person, see Instruction 5(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). Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. -----END PRIVACY-ENHANCED MESSAGE-----