-----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, TmHGBRd13lQKcLqhWthDO1bP/yhq6t8PUwESIiXhw1+VM9NVJSTCHutXXsYcjccV zwPAaZj4njuHbIgCT85LTQ== 0000950138-05-001100.txt : 20051103 0000950138-05-001100.hdr.sgml : 20051103 20051103165206 ACCESSION NUMBER: 0000950138-05-001100 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20051101 FILED AS OF DATE: 20051103 DATE AS OF CHANGE: 20051103 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ACTIVISION INC /NY CENTRAL INDEX KEY: 0000718877 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 954803544 STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DOORNINK RONALD CENTRAL INDEX KEY: 0001091428 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] STATE OF INCORPORATION: DE FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15839 FILM NUMBER: 051177568 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 nov3_doornink-4ex.xml ACTIVIS\2005\NOV FORM 4S\NOV 3 DOORNINK-4 X0202 4 2005-11-01 0 0000718877 ACTIVISION INC /NY ATVI 0001091428 DOORNINK RONALD C/O ACTIVISION, INC. 3100 OCEAN PARK BLVD SANTA MONICA CA 90405 1 1 0 0 President Common Stock, par value $.000001 per share 2005-11-01 4 M 0 333333 5.735 A 508179 I See Footnote 1 Common Stock, par value $.000001 per share 2005-11-01 4 S 0 183333 15.75 D 324846 I See Footnote 1 Common Stock, par value $.000001 per share 2005-11-01 4 S 0 10000 15.76 D 314846 I See Footnote 1 Common Stock, par value $.000001 per share 2005-11-01 4 S 0 80000 15.77 D 234846 I See Footnote 1 Common Stock, par value $.000001 per share 2005-11-01 4 S 0 35000 15.78 D 199846 I See Footnote 1 Common Stock, par value $.000001 per share 2005-11-01 4 S 0 25000 15.80 D 174846 I See Footnote 1 Employee Stock Options 5.735 2005-11-01 4 M 0 333333 0 D 2012-07-22 Common Stock 333333 1900000 I See Footnote 1 By the Ronald Doornink Martha Doornink TTEE U/A/D 12-17-1996 FBO Doornink Rev Living Trust. These options vested in three equal annual installments beginning on April 1, 2003. ***George L. Rose was granted a power of attorney to sign all Forms 4 and Forms 5 on behalf of Ronald Doornink. /s/ George L. Rose*** 2005-11-03 -----END PRIVACY-ENHANCED MESSAGE-----