-----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, N02S8HiO/nz69JXnXhZYmvTt+o1ICnrct/im4v3Rucq5cZt6JX1rQ23Z/apJ5OCu 0OFwLeLraU8QZlvhSdbSlg== 0000909143-01-000005.txt : 20010123 0000909143-01-000005.hdr.sgml : 20010123 ACCESSION NUMBER: 0000909143-01-000005 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20010101 FILED AS OF DATE: 20010111 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ADAMS GOLF INC CENTRAL INDEX KEY: 0001059763 STANDARD INDUSTRIAL CLASSIFICATION: [3949] IRS NUMBER: 752320087 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-24583 FILM NUMBER: 1507227 BUSINESS ADDRESS: STREET 1: 2801 EAST PLANO PARKWAY CITY: PLANO STATE: TX ZIP: 75074 BUSINESS PHONE: 9726739000 MAIL ADDRESS: STREET 1: 2801 EAST PLANO PARKWAY CITY: PLANO STATE: TX ZIP: 75074 COMPANY DATA: COMPANY CONFORMED NAME: FLEISCHER RUSSELL L CENTRAL INDEX KEY: 0001108424 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 2801 PLANO PARKWAY CITY: PLANO STATE: TX ZIP: 75074 BUSINESS PHONE: 9726739000 MAIL ADDRESS: STREET 1: 2801 PLANO PARKWAY CITY: PLANO STATE: TX ZIP: 75074 3 1 0001.txt OMB APPROVAL ----------------------------- OMB Number 3235-0104 Expires: December 31, 2001 Estimated average burden hours per response ....... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 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(f) of the Investment Company Act of 1940 ====================================================================== 1. Name and Address of Reporting Person Fleischer Russell L. - ---------------------------------------------------------------------- (Last) (First) (Middle) 2801 East Plano Parkway - ---------------------------------------------------------------------- (Street) Plano Texas 75070 - ---------------------------------------------------------------------- (City) (State) (Zip) ====================================================================== 2. Date of Event Requiring Statement (Month/Day/Year) 01/01/2001 ====================================================================== 3. IRS Identification Number of Reporting Person, if an entity (voluntary) ====================================================================== 4. Issuer Name and Ticker or Trading Symbol Adams Golf, Inc. (ADGO) ====================================================================== 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) [ ] Director [ ] 10% Owner [ X ] Officer (give title below) [ ] Other (specify below) Chief Financial Officer and Treasurer ---------------------------------------------- ===================================================================== 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 ================================================================================================================================= 2. 3. 1. Amount of Securities Ownership Form Title of Security Beneficially Owned Direct (D) or 4. (Instr. 4) (Instr. 4) Indirect (I) Nature of Indirect Beneficial Ownership - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- ================================================================================================================================= 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 5(b)(v).
FORM 3 (continued)
Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ==================================================================================================================================== 3. Title and Amount 2. of Securities Date Exercisable and Underlying 5. Expiration Date Derivative Security 4. Ownership (Month/Day/Year) (Instr. 4) Conversion Form of 6. 1. -------------------- ------------------- or Exercise Derivative Nature Title of Date Expira- Amount or Price of Security: of Indirect Derivative Security Exer- tion Number of Derivative Direct (D) Beneficial (Instr. 4) cisable Date Title Shares Security or Indirect (I) Ownership - --------------------------------------------------------------------------------------------------------------------------------- Employee Stock Options Common (Right to Purchase) (1) 11/01/2005 Stock 100,000 $1.063 D - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- =================================================================================================================================
Explanation of Responses: (1) The Options vest in four equal annual installments beginning on the first anniversary of the date of grant (November 1, 2000) and continuing on successive anniversaries thereafter. /s/ RUSSELL L. FLEISCHER 01/10/2001 - ----------------------------------------- ------------------ **Signature of Reporting Person Date ** 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. -----END PRIVACY-ENHANCED MESSAGE-----