-----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, AHMeYQD8AltkD/NVSJOGpCt9rdK/wue6r6Qqo5aH8CaqeWWIwrwub7/9bKZGWJ/I aUUzVsuq4qqS1rao7ip1Hg== 0000909143-99-000039.txt : 19990217 0000909143-99-000039.hdr.sgml : 19990217 ACCESSION NUMBER: 0000909143-99-000039 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981231 FILED AS OF DATE: 19990216 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: 5 SEC ACT: SEC FILE NUMBER: 000-24583 FILM NUMBER: 99541650 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: ADAMS B H CENTRAL INDEX KEY: 0001065610 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 5 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 5 1 ----------------------------- OMB APPROVAL ----------------------------- OMB Number 3235-0362 Expires: September 30, 1998 Estimated average burden hours per response ....... 1.0 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 5 ANNUAL 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). [ ] FORM 3 HOLDINGS REPORTED. [ ] FORM 4 TRANSACTIONS REPORTED. ====================================================================== 1. Name and Address of Reporting Person Adams B. H. (Barney) - ---------------------------------------------------------------------- (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. (ADGO) ====================================================================== 3. IRS or Social Security Number of Reporting Person (Voluntary) ====================================================================== 4. Statement for Month/Year December 1998 ====================================================================== 5. If Amendment, Date of Original (Month/Year) ====================================================================== 6. Relationship of Reporting Person to Issuer (Check all applicable) [ X ] Director [ X ] 10% Owner [ X ] Officer (give title below) [ ] Other (specify below) President and CEO --------------------------- ====================================================================== 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 Issuer's Indirect Ownership Title of Security Date ------------ or Fiscal Year (I) (Instr. (Instr. 3) (mm/dd/yy) Code Amount (D) Price (Instr 3 & 4) (Instr.4) 4) - --------------------------------------------------------------------------------------------------------------------------------- Common Stock, par value $.001 12/08/98 G 6,000 D N/A - --------------------------------------------------------------------------------------------------------------------------------- Common Stock, par value $.001 12/08/98 G 1,777 D N/A 3,353,544 D - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- ================================================================================================================================= Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly
FORM 5 (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 of 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 Year (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code (A) (D) cisable Date Title Shares 5) 4) 4) 4) - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- =================================================================================================================================
Explanation of Responses: /s/ B. H. Adams 02/11/99 - -------------------------------------------- ------------- **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-----