5 1 file001.txt FORM 5 FORM 5 [ ] Check this box if no longer subject _________________________________ to Section 16. Form 4 or Form 5 | OMB APPROVAL | obligations may continue. See _________________________________ Instruction 1(b). | OMB Number: 3235-0362 | | Expires: December 31, 2001 | [ ] Form 3 Holdings Reported | Estimated average burden | | hours per response.....1.0 | [ ] Form 4 Transactions Reported _________________________________ UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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 _______________________________________________________________________________ 1. Name and Address of Reporting Person* Cousens Rodney ----------------------------------------------------- (Last) (First) (Middle) Acclaim Entertainment, Ltd. Moreau House, 112-120 Brompton Road, Knightsbridge ----------------------------------------------------- (Street) London England SW31JJ ----------------------------------------------------- (City) (State) (Zip) _______________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Acclaim Entertainment, Inc. (AKLM) _______________________________________________________________________________ 3. IRS Identification Number of Reporting Person (Voluntary) _______________________________________________________________________________ 4. Statement for Month/Year August, 2001 _______________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) _______________________________________________________________________________ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [ ] 10% Owner [ ] Director [X] Officer (give title below) [ ] Other (specify below) President and Chief Operating Officer, Acclaim Europe _______________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [ ] Form filed by more than one Reporting Person _______________________________________________________________________________ Page 1 FORM 5 (continued)
TABLE I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. --------------------- -------- ---------- ------------------------------ ----------- ---------- ---------- Amount of Securities Beneficially Owner- Owned at ship Trans- Securities Acquired (A) End of Form: action or Disposed of (D) Issuer's Direct Nature of Date Trans- (Instr. 3, 4 and 5) Fiscal (D) or Indirect Title of (Month/ action ---------------------------- Year Indirect Beneficial Security Day/ Code Amount (A) or Price (Instr. (I) Ownership (Instr. 3) Year) (Instr. 8) (D) 3 and 4) (Instr. 4) (Instr. 4) --------------------- -------- ---------- ----------- ------ --------- ----------- ---------- ---------- ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------
*If the form is filed by more than one reporting person, see Instruction 4(b)(v). Potential persons who are to resond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. (Over) SEC 2270 (3/99) Page 2 FORM 5 (continued)
TABLE II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g. puts, calls, warrants, options, convertible securities) ------------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. ---------- -------- -------- -------- ---------- ------------ -------------- ------ ---------- --------- ---------- Title and Ownership Number of Date Exer- Amount of of Derivative cisable and Underlying Number of Deriv- Securities Expiration Securities Price Derivative ative Conver- Acquired (A) Date (Month/ (Instr. 3 of Securities Security: sion or Trans- or Disposed Day/Year) and 4) Deriv- Benefi- Direct Exercise action Trans- of (D) -------------- -------------- ative cially (D) or Nature of Title of Price of Date action (Instr. 3, Date Amount Secur- Owned at Indirect Indirect Derivative Deriv- (Month/ Code 4, and 5) Exer- Expir- or Num- ity End of (I) Beneficial Security ative Day/ (Instr. ---------- cis- ation ber of (Instr. Month (Instr. Ownership (Instr. 3) Security Year) 8) (A) (D) able Date Title Shares 5) (Instr. 4) 4) (Instr. 4) ---------- -------- -------- -------- ---- ---- ------- ----- ----- ------ ------ ---------- -------- ---------- ----------------------------------------------------------------------------------------------------------------------------------- Option (Right to Buy)(1) $3.57 6/18/01 A 300,000 (1) 6/17/11 (2) 300,000 -- 300,000 D ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: (1) This option was granted to the Reporting Person under the Issuer's 1998 Stock Incentive Plan. Such option becomes exercisable in one-third installments on each of June 18, 2002, June 18, 2003, and June 18, 2004. (2) Common Stock, par value $0.02 per share. /s/ Rodney Cousens October 10, 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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number. Page 3