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