-----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, Txrzqcc9mA0ltAO0J+pZg8e5jSQCWOUJYLLCYcO82n0g7OyuwaE6xdEAzCz4vWIT sGdSMu9w1d/rZOeOMifLUQ== 0000910643-00-000003.txt : 20000202 0000910643-00-000003.hdr.sgml : 20000202 ACCESSION NUMBER: 0000910643-00-000003 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991231 FILED AS OF DATE: 20000110 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ACTIVISION INC /NY CENTRAL INDEX KEY: 0000718877 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 942606438 STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-12699 FILM NUMBER: 504194 BUSINESS ADDRESS: STREET 1: 3100 OCEAN PARK BLVD STREET 2: STE 1000 CITY: SANTA MONICA STATE: CA ZIP: 90405 BUSINESS PHONE: 3102552000 MAIL ADDRESS: STREET 1: 11601 WILSHIRE BLVD 3RD FL STREET 2: STE 1000 CITY: LOS ANGELES STATE: CA ZIP: 90025 FORMER COMPANY: FORMER CONFORMED NAME: MEDIAGENIC DATE OF NAME CHANGE: 19920703 FORMER COMPANY: FORMER CONFORMED NAME: ACTIVISION INC DATE OF NAME CHANGE: 19880829 COMPANY DATA: COMPANY CONFORMED NAME: GOLDBERG LAWRENCE CENTRAL INDEX KEY: 0001091427 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] OFFICER STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 3100 OCEAN PARK BLVD STREET 2: STE 1000 CITY: SANTA MONICA STATE: CA ZIP: 90405 BUSINESS PHONE: 3102552000 MAIL ADDRESS: STREET 1: 3100 OCEAN PARK BLVD CITY: SANTA MONICA STATE: CA ZIP: 90405 4 1
U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 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 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Issuer (Check all applicable) Goldberg Lawrence Activision, Inc. (ATVI) ___ Director ___ 10% Owner __________________________________________ _____________________________________________ X Officer (give ___ Other (Specify (Last) (First) (Middle) 3. IRS or Social 4. Statement for ___ title below) below) Security Number of Month/Year c/o Activision, Inc. Reporting Person Executive Vice President 3100 Ocean Park Boulevard (Voluntary) December 1999 ______________________________________________________________ __________________________________________ (Street) 5. If Amendment, Date of 7. Individual or Joint/Group Filing Original (Month/Year) (Check Applicable Line) Santa Monica California 90405 X Form Filed by One Reporting Person __________________________________________ ___ (City) (State) (Zip) ___ Form Filed by More Than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 5. Amount of 3. Trans- 4. Securities Acquired (A) Securities 2. Trans- action or Disposed of (D) Beneficially 6. Ownership action Code (Instr. 3, 4 and 5) Owned at Form: 7. Nature of Date (Instr. --------------------------- End of Direct(D) Indirect (Month/ 8) (A) Month or Beneficial 1. Title of Security Day/ Amount or Price (Instr. Indirect(I) Ownership (Instr.3) Year) (D) 3 and 4) (Instr. 4) (Instr. 4) - ----------------------------- --------- ---------- -------- --- -------- ------------ ------------- ------------ Common Stock, par value $.000001 per share 12/16/99 M 5,000 A $9.50 Common Stock, par value $.000001 per share 12/16/99 S 5,000 D $16.375 1,677 D * If this form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) 2. Conver- 5. Number of Deriv- 6. Date Exercisable sion or 3. Trans- 4. Trans- ative Securities and Expiration Date Exercise action action Acquired (A) or (Month/Day/Year) Price of Date Code Disposed of (D) ----------------------- Deriv- (Month/ (Instr. 8) (Instr. 3, 4, and 5) Date 1. Title of Derivative Security ative Day/ ----- ---- ----------------------- Exercis- Expiration (Instr. 3) Security Year) Code V (A) (D) able Date - ---------------------------------- ----------- ---------- ------------ ----------- ----------- ---------- ---------- Employee Stock Options $9.50 12/14/99 M 5,000 3/24/98 3/24/08 9. Number of 10. Ownership Derivative Form of Securities Derivative 7. Title and Amount of Underlying Benefi- Security: Securities (Instr. 3 and 4) cially Direct 11. Nature of --------------------------------- 8. Price of Owned (D) or Indirect Amount or Derivative at End Indirect Beneficial 1. Title of Derivative Title Number of Security of Month (I) Ownership Security (Instr. 3) Shares (Instr. 5) (Instr. 4) (Instr. 4) (Instr. 4) - ---------------------- -------------------- --------- ------------- ------------- -------------- -------------- Employee Stock Options Common Stock 5,000 183,666 D Expanation of Responses /s/ Lawrence Goldberg 01/10/2000 **Intentional misstatements or omissions of facts constitute ------------------------------- ----------- Federal Criminal Violations. See 18 U.S.C. 1001 and **Signature of Reporting Person Date 15 U.S.C. 78ff(a). Lawrence Goldberg Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure.
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