-----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, NUvM7YpIVPBAwM9xviy8mNJjcBwCZxoQttgZaSwUz57gtMLEk6nIKySYIP7tFkNU wMHKoodTA+Shp+SZQCeuHg== 0001005477-01-001206.txt : 20010223 0001005477-01-001206.hdr.sgml : 20010223 ACCESSION NUMBER: 0001005477-01-001206 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000630 FILED AS OF DATE: 20010215 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CONVERSE INC CENTRAL INDEX KEY: 0000716934 STANDARD INDUSTRIAL CLASSIFICATION: RUBBER & PLASTICS FOOTWEAR [3021] IRS NUMBER: 041419731 STATE OF INCORPORATION: MA FISCAL YEAR END: 0102 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 001-13430 FILM NUMBER: 1547508 BUSINESS ADDRESS: STREET 1: ONE FORDHAM RD CITY: NORTH READING STATE: MA ZIP: 01864 BUSINESS PHONE: 5086641100 MAIL ADDRESS: STREET 1: ONE FORDHAM ROAD CITY: NORTH READING STATE: MA ZIP: 01864 COMPANY DATA: COMPANY CONFORMED NAME: ARTEMIS AMERICA PARTNERSHIP CENTRAL INDEX KEY: 0001092704 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: C/O RL&F SERVICE CORPORATION STREET 2: ONE RODNEY SQUARE CITY: WILMINGTON STATE: DE ZIP: 19801 MAIL ADDRESS: STREET 1: C/O RL&F SERVICE CORPORATION STREET 2: ONE RODNEY SQUARE CITY: WILMINGTON STATE: DE ZIP: 19801 5 1 0001.txt FORM 5 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 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). |X| Form 3 Holdings Reported |_| Form 4 Transactions Reported ================================================================================ 1. Name and Address of Reporting Person* Artemis America Partnership - -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o RL&F Services Corporation One Rodney Square - -------------------------------------------------------------------------------- (Street) Wilmington, DE 19801 - -------------------------------------------------------------------------------- (City) (State) (Zip) ================================================================================ 2. Issuer Name and Ticker or Trading Symbol Converse, Inc. [CVEO] ================================================================================ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ================================================================================ 4. Statement for Month/Year 12/00 ================================================================================ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Person to Issuer (Check all applicable) |_| Director |X| 10% Owner |_| Officer (give title below) |_| Other (specify below) ________________________________________________ ================================================================================ 7. Individual or Joint/Group Filing (Check Applicable Line) |_| Form filed by One Reporting Person |X| Form filed by More than One Reporting Person ================================================================================ * If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
5. 6. 4. Amount of Owner- Security Acquired (A) or Securities ship Disposed of (D) Beneficially Form: 7. (Instr. 3, 4 and 5) Owned at End Direct Nature of 2. 3. ----------------------------- of Issuer's (D) or Indirect 1. Transaction Transaction (A) Fiscal Year Indirect Beneficial Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, without par value 6/30/00 J(1) 5,614,054(1) A N/A(1) 5,614,054 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 or Derivative 6. of Underlying 8. ities Secur- of Exer- Securities Date Securities Price Bene- ity: In- cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) Shares were transferred to Artemis America Partnership ("Artemis") in connection with the transfer to Artemis of voting rights previously beneficially held by Lion Advisors, L.P. in a managed account on behalf of Artemis. /s/ Emmanuel Cueff February 15, 2001 - --------------------------------------------- ----------------------- **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. Joint Filer Information Name: Artemis Finance SNC Address: 5 Boulevard de Latour Maubourg 75007, Paris, France Designated Filer: Artemis America Partnership (1)(2) Issuer & Ticker Symbol: Converse Inc. ("CVEO") Date of Event Requiring Statement: June 30, 2000 Signature: /s/ Emmanuel Cueff Date: February 15, 2001 ------------------ Name: Emmanuel Cueff Title: General Secretary of Artemis Finance SNC Joint Filer Information Name: Artemis SA Address: 5 Boulevard de Latour Maubourg 75007, Paris, France Designated Filer: Artemis America Partnership (1) Issuer & Ticker Symbol: Converse Inc. ("CVEO") Date of Event Requiring Statement: June 30, 2000 Signature: /s/ Emmanuel Cueff Date: February 15, 2001 ------------------ Name: Emmanuel Cueff Title: General Secretary of Artemis SA (1) Artemis SA and Artemis Finance SNC are general partners of Artemis America Partnership. (2) The Managing General Partner of Artemis Finance SNC is Artemis SA. -----END PRIVACY-ENHANCED MESSAGE-----