0001209191-12-014170.txt : 20120229
0001209191-12-014170.hdr.sgml : 20120229
20120229191223
ACCESSION NUMBER: 0001209191-12-014170
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120228
FILED AS OF DATE: 20120229
DATE AS OF CHANGE: 20120229
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BREWER OLIVER G III
CENTRAL INDEX KEY: 0001072918
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33978
FILM NUMBER: 12655108
MAIL ADDRESS:
STREET 1: 2801 EAST PLANO PARKWAY
CITY: PLANO
STATE: TX
ZIP: 75074
ISSUER:
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
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
4
1
c27592_4x0.xml
MAIN DOCUMENT DESCRIPTION
X0304
4
2012-02-28
0001059763
ADAMS GOLF INC
ADGF
0001072918
BREWER OLIVER G III
2801 EAST PLANO PARKWAY
PLANO
TX
75074
0
0
1
0
Former Pres., CEO and Director
Common Stock
2012-02-28
4
M
0
119778
0.04
A
775706
D
Common Stock
2012-02-28
4
M
0
66694
0.04
A
842400
D
Employee Stock Option (right to buy)
0.04
2012-02-28
4
M
0
119778
0
D
2004-01-31
2013-07-31
Common Stock
119778
0
D
Employee Stock Option (right to buy)
0.04
2012-02-28
4
M
0
66694
0
D
2004-07-15
2014-01-15
Common Stock
66694
0
D
The reporting person states that neither the filing of this statement nor anything herein shall be deemed an admission that such person is, for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise, the beneficial owner of any securities covered by this statement. The reporting person disclaims beneficial ownership of the securities covered by this statement, except to the extent of his pecuniary interest therein.
On February 24, 2012, the reporting person and the Issuer entered into that certain Separation Agreement and Release (the "Separation Agreement"), pursuant to which, effective February 29, 2012, the reporting person resigned as President and Chief Executive Officer and a director of the Issuer. The Separation Agreement provides, among other things, that 75,000 unvested shares of restricted stock, previously granted to the reporting person by the Issuer on November 9, 2009, will no longer be subject to immediate forfeiture upon the reporting person's resignation. Instead, such shares of restricted stock will vest only upon the occurrence of a "change of control" (as defined in the Separation Agreement), provided that such a "change of control" is publicly announced on or prior to June 30, 2012.
/s/ O.G. Brewer III
2012-02-29