-----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, WFrwThYeCiszWsqB0B2GKK71Hq9y05gu9yUgFyATDNT/HAxftuWGreo8to0Fjv16 nkr0AuFjoLSVFbb6VSTsBQ== 0000909143-03-000031.txt : 20030218 0000909143-03-000031.hdr.sgml : 20030217 20030218163937 ACCESSION NUMBER: 0000909143-03-000031 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030214 FILED AS OF DATE: 20030218 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24583 FILM NUMBER: 03571319 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 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: PATCHIN STEPHEN R CENTRAL INDEX KEY: 0001065614 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 2801 EAST PLANO PKWY CITY: PLANO STATE: TX ZIP: 75074 BUSINESS PHONE: 9726739601 MAIL ADDRESS: STREET 1: 2801 EAST PLANO PKWY CITY: PLANO STATE: TX ZIP: 75074 4 1 patchin-form4.txt STEPHEN R. PATCHIN - FORM 4 DATED FEBRUARY 14, 2003 ----------------------------- OMB APPROVAL ----------------------------- OMB Number 3235-0287 Expires: December 31, 2005 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 Patchin Stephen R. - ---------------------------------------------------------------------- (Last) (First) (Middle) 2801 East Plano Parkway - ---------------------------------------------------------------------- (Street) Plano TX 75074 - ---------------------------------------------------------------------- (City) (State) (Zip) ====================================================================== 2. Issuer Name and Ticker or Trading Symbol Adams Golf, Inc. (ADGO) ====================================================================== 3. IRS Identification Number of Reporting Person, if an entity (Voluntary) ====================================================================== 4. Statement for Month/Day/Year 02/14/2003 ====================================================================== 5. If Amendment, Date of Original (Month/Day/Year) ====================================================================== 6. Relationship of Reporting Person to Issuer (Check all applicable) [ X ] Director [ X ] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) ------------------------------------------ ====================================================================== 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. 2A. 4. 5. Owner- 2. Deemed Securities Acquired (A) or Amount of ship Trans- Execution 3. Disposed of (D) Securities Form: 7. Nature action Date, if Transaction (Instr. 3, 4 and 5) Beneficially Direct of Indirect Date any Code --------------------------- Owned at End (D) or Beneficial 1. (Month/ (Month/ (Instr. 8) (A) of Month Indirect Ownership Title of Security Day/ Day/ ------------ Amount or Price (Instr. 3 (I) (Instr. (Instr. 3) Year Year) 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- 3A. 4. Securities Date Securities Price Bene- ity: In- cise 3. Deemed Trans- Acquired (A) Exercisable and Instr. 3 and 4) of ficially Direct direct Price Trans- Execution action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Date, if Code of (D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date any (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ Day/ ------- ---------------- Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Year Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Stock Options (right to 02/14/ 02/14/ Common purchase) $0.31 2003 A 50,000 (1) 2013 Stock 50,000 50,000 D - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) The Options vest as follows: 12,500 options vest on 01/29/2004, 12,500 options vest on 01/29/2005, 12,500 options vest on 01/29/2006, and 12,500 options vest on 01/29/2007. /s/ STEPHEN R. PATCHIN 02/18/2003 - ----------------------------------------- ------------- **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-----