-----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, GUwFS9kOdJ9QpYBhYQo+5xnZ5ihDpM37dRPoaWZZ1LIw1uMeSstbc2WpUOkwzgdQ ZfVJL0Xqa6A5d59iXbVqzA== /in/edgar/work/0000351903-00-000040/0000351903-00-000040.txt : 20001011 0000351903-00-000040.hdr.sgml : 20001011 ACCESSION NUMBER: 0000351903-00-000040 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000930 FILED AS OF DATE: 20001010 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: JACKPOT ENTERPRISES INC CENTRAL INDEX KEY: 0000351903 STANDARD INDUSTRIAL CLASSIFICATION: [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: 737272 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: HIRSCHFIELD ALAN J CENTRAL INDEX KEY: 0000941417 STANDARD INDUSTRIAL CLASSIFICATION: [ ]DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 3490 CLUBHOUSE DR 1-2 CITY: WILSON STATE: WY ZIP: 83004 BUSINESS PHONE: 3077339742 MAIL ADDRESS: STREET 1: 3490 CLUBHOUSE DR 1-2 CITY: WILSON STATE: WY ZIP: 83014 4 1 0001.txt ------------------------------ 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* HIRSCHFIELD ALAN J. ________________________________________________________________________________ (Last) (First) (Middle) 1110 PALMS AIRPORT DRIVE ________________________________________________________________________________ (Street) LAS VEGAS NV 89119 ________________________________________________________________________________ (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol JACKPOT ENTEPRISES, INC. (J) ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ###-##-#### ________________________________________________________________________________ 4. Statement for Month/Year SEPTEMBER 2000 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] 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) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ COMMON STOCK PAR VALUE $.01 257,500 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
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 $10.625 5/01/00 1/31/05 Common 27,500 27,500 D Common Stock Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to Buy $10.125 1/31/01 1/31/10 Common 50,000 50,000 D Common Stock Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to Buy $10.125 1/31/02 1/31/10 Common 50,000 50,000 D Common Stock Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to Buy $10.125 1/31/03 1/31/10 Common 50,000 50,000 D Common Stock Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Convertible $10.75 6/01/01 3/31/07 Common 23,256 23,256 I Alan J. Debt Stock Hirschfield Par Value GST Exempt $.01 Trust - ------------------------------------------------------------------------------------------------------------------------------------ Convertible $10.75 6/01/01 3/31/07 Common 93,023 93,023 I Alan J. Debt Stock Hirschfield Par Value Living Trust $.01 - ------------------------------------------------------------------------------------------------------------------------------------ Option to Buy $ 9.50 9/29/00 A 09/29/00 6/30/05 Common 27,500 27,500 D Stock Par Value $.01 - ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: /s/ Alan J. Hirschfield 10/10/00 - --------------------------------------------- ----------------------- **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-----