4 1 0001.txt ----------------------------- OMB APPROVAL ----------------------------- OMB Number 3235-0287 Expires: December 31, 2001 Estimated average burden hours per response ..... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 [ ] CHECK THIS BOX IF NO LONGER SUBJECT OF SECTION 16. FORM 4 OR FORM 5 OBLIGATIONS MAY CONTINUE. SEE INSTRUCTION 1(B). ====================================================================== 1. Name and Address of Reporting Person Brewer Oliver (Chip) G. III ---------------------------------------------------------------------- (Last) (First) (Middle) 2801 East Plano Parkway ---------------------------------------------------------------------- (Street) Plano Texas 75074 ---------------------------------------------------------------------- (City) (State) (Zip) ====================================================================== 2. Issuer Name and Ticker or Trading Symbol Adams Golf, Inc. (AGDO) ====================================================================== 3. IRS or Social Security Number of Reporting Person (Voluntary) ====================================================================== 4. Statement for Month/Year September 2000 ====================================================================== 5. If Amendment, Date of Original (Month/Year) ====================================================================== 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [ ] 10% Owner [ X ] Officer (give title below) [ ] Other (specify below) President and Chief Operating Officer ------------------------------------------ ====================================================================== 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 Acquired, Disposed of, or Beneficially Owned ================================================================================================================================= 6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Nature Transaction (Instr. 3, 4 and 5) Beneficially Direct of Indirect 2. Code ------------------------------- Owned at End (D) or Beneficial 1. Transaction (Instr. 8) (A) of Month Indirect Ownership Title of Security Date ------------ Amount or Price (Instr. 3 (I) (Instr. (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) 4) ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- =================================================================================================================================== Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly
FORM 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) =================================================================================================================================== 9. 10. Number Owner- of ship 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ----------------- Deriv- Owned (D) or Bene- 1. of action Code of (D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------- ---------------- Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ----------------------------------------------------------------------------------------------------------------------------------- Employee Stock Option (Right to 08/01 08/01 Common Purchase) $1.25 2000 A V 200,000 (1) 2005 Stock 200,000 200,000 D ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ===================================================================================================================================
Explanation of Responses: (1) The Options vest in four (4) equal annual installments beginning 08/01/2001. /s/ O.G. BREWER 10/04/2000 -------------------------------------------- ------------- Oliver G. (Chip) Brewer III Date **Signature of Reporting Person ** 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 provided is insufficient, see Instruction 6 for procedures.