-----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, SoFs8UtMHVgm9jHN+hxDboFG+DrSdLa6nAbnyQ7Is49kxemMzUVzI1dFL2NYZutC qeQZ5reG8R84VZ770ie07A== 0001047469-03-002263.txt : 20030123 0001047469-03-002263.hdr.sgml : 20030123 20030123122620 ACCESSION NUMBER: 0001047469-03-002263 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030122 FILED AS OF DATE: 20030123 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: ROBSON KEN CENTRAL INDEX KEY: 0001207778 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 1809 WINDING WAY CITY: RICHMOND STATE: VA ZIP: 23235 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SHUFFLE MASTER INC CENTRAL INDEX KEY: 0000718789 STANDARD INDUSTRIAL CLASSIFICATION: MISCELLANEOUS MANUFACTURING INDUSTRIES [3990] IRS NUMBER: 411448495 STATE OF INCORPORATION: MN FISCAL YEAR END: 1031 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-20820 FILM NUMBER: 03521883 BUSINESS ADDRESS: STREET 1: 1106 PALMS AIRPORT DRIVE CITY: LAS VEGAS STATE: NV ZIP: 89119 BUSINESS PHONE: 7028977150 4 1 a2101351z4.htm FORM 4

        FORM 4

o Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

(Print or Type Responses)
  UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

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(h) of the Investment Company Act of 1940
 
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1.   Name and Address of Reporting Person*   2.   Issuer Name and Ticker or Trading Symbol   6.   Relationship of Reporting Person(s) to Issuer
(Check all applicable)
    Robson   Ken           SHUFFLE MASTER, INC. (SHFL)         X   Director            10% Owner

 
           
    (Last)   (First)   (Middle)   3.   I.R.S. Identification Number of Reporting Person, if an entity (voluntary)   4.   Statement for
Month/Day/Year
               Officer
        (give title below)
           Other
        (specify below)
    1809 Winding Way               January 22, 2003            

 
 
     
(Street)           5.   If Amendment, Date of Original (Month/Day/Year)   7.   Individual or Joint/Group Filing
(Check Applicable Line)
    X     Form filed by One Reporting Person
             Form filed by More than
    Richmond   VA   23235                                   One Reporting Person

    (City)   (State)   (Zip)                            
                Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1.   Title of Security
(Instr. 3)
  2.   Transaction Date
(Month/Day/Year)
  2A.   Deemed Execution Date, if any
(Month/Day/Year)
  3.   Transaction Code
(Instr. 8)
  4.   Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
  5.   Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
  6.   Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
  7.   Nature of Indirect Beneficial Ownership
(Instr. 4)
                   
                       
                            Code   V       Amount   (A) or (D)   Price                        

Common Stock   1/22/03               P           250   A   $17.85               Direct        

                                                10,250                

                                                                         

                                                                         

                                                                         

                                                                         

                                                                         

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).

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FORM 4 (Continued)   Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
(
e.g., puts, calls, warrants, options, convertible securities)

1.   Title of Derivative Security
(Instr. 3)
  2.   Conversion or Exercise Price of Derivative Security   3.   Transaction Date
(Month/Day/Year)
  3A.   Deemed Execution Date, if any
(Month/Day/Year)
  4.   Transaction Code
(Instr. 8)
  5.   Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
  6.   Date Exercisable and Expiration Date (Month/Day/Year)
                               
 
                                    Code   V       (A)   (D)       Date
Exercisable
  Expiration Date

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 

                                                                 


7.   Title and Amount of Underlying Securities
(Instr. 3 and 4)
  8.   Price of Derivative Security
(Instr. 5)
  9.   Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
  10.   Ownership Form of Derivative Securities: Direct (D) or Indirect (I) (Instr. 4)   11.   Nature of Indirect Beneficial Ownership
(Instr. 4)
   
                               
    Title   Amount or Number of Shares                                

                                         

                                         

                                         

                                         

                                         

                                         

                                         

                                         

                                         

                                         

Explanation of Responses:



/s/ Jerry Smith   January 22, 2003

Jerome R. Smith, Attorney In Fact
**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 is insufficient,
see Instruction 6 for procedure.

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