-----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, Vyu92UKHUmj921mL1i5+b50kWGZukYuRoAh6Htf9Eek/UOGjjqJmRmdZOFwJjm8/ aM3oa2yUBzUFDtN9UkK7bw== 0001023115-96-000003.txt : 19960919 0001023115-96-000003.hdr.sgml : 19960919 ACCESSION NUMBER: 0001023115-96-000003 CONFORMED SUBMISSION TYPE: SC 13D PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19960918 SROS: NYSE SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: JACKPOT ENTERPRISES INC CENTRAL INDEX KEY: 0000351903 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISCELLANEOUS AMUSEMENT & RECREATION [7990] IRS NUMBER: 880169922 STATE OF INCORPORATION: NV FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: SC 13D SEC ACT: 1934 Act SEC FILE NUMBER: 005-33496 FILM NUMBER: 96631707 BUSINESS ADDRESS: STREET 1: 1110 PALMS AIRPORT DR CITY: LAS VEGAS STATE: NV ZIP: 89119 BUSINESS PHONE: 7023693424 MAIL ADDRESS: STREET 2: 1110 PALMS AIRPORT DRIVE CITY: LAS VEGAS STATE: NV ZIP: 89119 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: KORNSTEIN DON R CENTRAL INDEX KEY: 0001023115 STANDARD INDUSTRIAL CLASSIFICATION: [] FILING VALUES: FORM TYPE: SC 13D BUSINESS ADDRESS: STREET 1: 1110 PALMS AIRPORT DR CITY: LAS VEGAS STATE: NV ZIP: 89119 BUSINESS PHONE: 7022635555 MAIL ADDRESS: STREET 1: DON R KORNSTEIN STREET 2: 1110 PALMS AIRPORT DR CITY: LAS VEGAS STATE: NV ZIP: 89119 SC 13D 1 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13D Under the Securities Exchange Act of 1934 (Amendment No. )* JACKPOT ENTERPRISES, INC. __________________________________________________________________________ (NAME OF ISSUER) COMMON STOCK __________________________________________________________________________ (TITLE CLASS OF SECURITIES) 466392 10 7 __________________________ (CUSIP NUMBER) Alan Annex, Esq. Camhy Karlinsky & Stein 1740 Broadway New York, NY 10019 ___________________________________________________________________________ (Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications) September 8, 1996 ______________________________________________________ (Date of Event which Required Filing of this Statement) If the filing person has previously filed a statement on Schedule 13G to report the acquisition which is the subject of this Schedule 13D, and is filing this schedule because of Rule 13d-1(b)(3) or (4), check the following box . Check the following box if a fee is being paid with the statement X . (A fee is not required only if the reporting person: (1) has a previous statement on file reporting beneficial ownership of more than five percent of the class of securities described in Item 1; and (2) has filed no amendment subsequent thereto reporting beneficial ownership of five percent or less of such class.) (See Rule 13-d-7.) Note: Six copies of this statement, including all exhibits, should be filed with the Commission. See Rule 13d-1(a) for other parties to whom copies are to be sent. *The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosures provided in a prior cover page. The information required on the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes). SCHEDULE 13D CUSIP No. 466392 10 7 Page 1 of 3 Pages 1 NAME OF REPORTING PERSON S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON: Don R. Kornstein Social Security No. ###-##-#### ______________________________________________________________________________ 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* ______________________________________________________________________________ 3 SEC USE ONLY ______________________________________________________________________________ 4 SOURCE OF FUNDS* N/A ______________________________________________________________________________ 5 CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d) OR 2(e) ______________________________________________________________________________ 6 CITIZENSHIP OR PLACE OF ORGANIZATION: United States ______________________________________________________________________________ NUMBER OF 7 SOLE VOTING POWER: 521,666 SHARES _______________________________________________________ BENEFICIALLY OWNED BY 8 SHARED VOTING POWER: EACH _______________________________________________________ REPORTING PERSON WITH 9 SOLE DISPOSITIVE POWER: 521,666 _______________________________________________________ 10 SHARED DISPOSITIVE POWER: _______________________________________________________ 11 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON: 521,666 ______________________________________________________________________________ 12 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES* ______________________________________________________________________________ 13 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11): 5.28% ______________________________________________________________________________ 14 TYPE OF REPORTING PERSON*: IN ______________________________________________________________________________ Item 1. Security and Issuer This statement relates to options to purchase Common Stock, par value $.01 per share of Jackpot Enterprises, Inc. ("Issuer"), held by Don R. Kornstein. The principal executive offices of the Issuer are located at 1110 Palms Airport Drive Las Vegas, Nevada 89119 Item 2. Identity and Background (a) Don R. Kornstein (b) 1110 Palms Airport Drive, Las Vegas, Nevada 89119 (c) President and Chief Executive Officer Jackpot Enterprises, Inc. 1110 Palms Airport Drive Las Vegas, Nevada 89119 (d) Not applicable (e) Not applicable (f) United States Item 3. Source and Amount of Funds or Other Consideration On September 8, 1994, in connection with his employment with the Issuer, Mr. Kornstein was granted options to purchase 700,000 shares of Jackpot Enterprises, Inc. Common Stock, vesting as follows: 233,333 - September 8, 1995 233,333 - September 8, 1996 233,334 - September 8, 1997 On June 30, 1995, Mr. Kornstein was granted options to purchase 27,500 shares of Jackpot Enterprises, Inc. Common Stock which vested on September 30, 1995. On June 30, 1996, Mr. Kornstein was granted options to purchase 27,500 shares of Jackpot Enterprises, Inc. Common Stock which will vest on September 30, 1996. Item 4. Purpose of Transaction See Item 3. Item 5. Interest in Securities of Issuer (a) Mr. Kornstein currently has exercisable options to purchase 521,666 shares of Jackpot Enterprises, Inc. Common Stock. Such options constitute 5.28% of the outstanding Common Stock of the Issuer, assuming Mr. Kornstein's options are exercised and such shares are outstanding. This amount does not include options to acquire 233,334 which are currently not exercisable. (b) Mr. Kornstein has sole power to dispose of or direct the disposition of the shares referred to in paragraph (a). (c) None (d) None (e) None Item 6. Contracts, Arrangements, Understandings or Relationships with Respect to Securities of the Issuer. None Item 7. Material to be Filed as Exhibits None Signature After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct. September 18, 1996 /s/ Don R. Kornstein ____________________ ____________________ Date Signature -----END PRIVACY-ENHANCED MESSAGE-----