-----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, AxftjOatT8EVyRW+GkFFIyJv73odxEW0JtiWlqBw2FFDrzEGHBUVseg0sz4gc6/m mX21Kv5qZ+PYxYTQ/8y+kA== 0000351903-00-000007.txt : 20000310 0000351903-00-000007.hdr.sgml : 20000310 ACCESSION NUMBER: 0000351903-00-000007 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000229 FILED AS OF DATE: 20000309 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: JACKPOT ENTERPRISES INC CENTRAL INDEX KEY: 0000351903 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISCELLANEOUS AMUSEMENT & RECREATION [7990] IRS NUMBER: 880169922 STATE OF INCORPORATION: NV FISCAL YEAR END: 0630 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 001-09728 FILM NUMBER: 564903 BUSINESS ADDRESS: STREET 1: 1110 PALMS AIRPORT DR CITY: LAS VEGAS STATE: NV ZIP: 89119 BUSINESS PHONE: 7022635555 MAIL ADDRESS: STREET 1: 1110 PALMS AIRPORT DRIVE STREET 2: 1110 PALMS AIRPORT DRIVE CITY: LAS VEGAS STATE: NV ZIP: 89119 COMPANY DATA: COMPANY CONFORMED NAME: KORNSTEIN DON R CENTRAL INDEX KEY: 0001023115 STANDARD INDUSTRIAL CLASSIFICATION: [] OTHER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 1110 PALMS AIRPORT DR CITY: LAS VEGAS STATE: NV ZIP: 89119 BUSINESS PHONE: 7022635555 MAIL ADDRESS: STREET 1: DON R KORNSTEIN STREET 2: 1110 PALMS AIRPORT DR CITY: LAS VEGAS STATE: NV ZIP: 89119 4 1 FORM 4 X Check this box if no longer _ subject to Section 16. Form 4 or Form 5 obligations may continue. See instruction 1(b). ------------------------------ OMB APPROVAL ------------------------------ OMB Number 3235-0287 Expires: 12-31-2001 Estimated average burden hours per response ....... 0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 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* Kornstein Don R. ________________________________________________________________________________ (Last) (First) (Middle) 1110 Palms Airport Drive ________________________________________________________________________________ (Street) Las Vegas NV 89119 ________________________________________________________________________________ (City) (State) (Zip) Jackpot Enterprises, Inc. (J) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol ###-##-#### ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) February 2000 ________________________________________________________________________________ 4. Statement for Month/Year ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [_] Director [_] 10% Owner [_] Officer (give title below) [_] Other (specify below) ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by 1 Reporting Person [_] Form filed by more than 1 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. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------- Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) (Over) SEC 1474(3-99) FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
10. 9. Owner- Number ship of Form 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- 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 Month (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ Option to buy Common Stock $9.25 09/08/1995 09/08/2004 Common 233,333 233,333 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to buy Common Stock $9.25 09/08/1996 09/08/2004 Common 233,333 233,333 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to buy Common Stock $9.25 09/08/1997 09/08/2004 Common 233,334 233,334 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to buy Common Stock $10.75 09/30/1995 06/30/2000 Common 27,500 27,500 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to buy Common Stock $10.00 09/30/1996 06/30/2001 Common 27,500 27,500 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to buy Common Stock $11.50 09/30/1997 06/30/2002 Common 27,500 27,500 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to buy Common Stock $ 9.9375 09/30/1998 06/30/2003 Common 27,500 27,500 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to buy Common Stock $ 8.75 09/30/1999 06/30/2004 Common 27,500 27,500 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to buy Common Stock $ 9.00 02/29/2000 09/14/2009 Common 15,000 15,000 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to buy Common Stock $ 9.00 02/29/2000 09/14/2009 Common 15,000 15,000 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: /s/ Don R. Kornstein 3/09/2000 - --------------------------------------------- ----------------------- **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 procedure. -----END PRIVACY-ENHANCED MESSAGE-----