0001209191-11-058131.txt : 20111128
0001209191-11-058131.hdr.sgml : 20111128
20111128135204
ACCESSION NUMBER: 0001209191-11-058131
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20111117
FILED AS OF DATE: 20111128
DATE AS OF CHANGE: 20111128
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: CASATI ROLAND E
CENTRAL INDEX KEY: 0000938870
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33978
FILM NUMBER: 111227846
MAIL ADDRESS:
STREET 1: 2801 EAST PIANO PARKWAY
CITY: PLANO
STATE: TX
ZIP: 75074
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: ADAMS GOLF INC
CENTRAL INDEX KEY: 0001059763
STANDARD INDUSTRIAL CLASSIFICATION: [3949]
IRS NUMBER: 752320087
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2801 EAST PLANO PARKWAY
CITY: PLANO
STATE: TX
ZIP: 75074
BUSINESS PHONE: 9726739000
MAIL ADDRESS:
STREET 1: 2801 EAST PLANO PARKWAY
CITY: PLANO
STATE: TX
ZIP: 75074
3
1
c25262_3x0.xml
MAIN DOCUMENT DESCRIPTION
X0204
3
2011-11-17
0
0001059763
ADAMS GOLF INC
ADGF
0000938870
CASATI ROLAND E
255 NORTH GREEN BAY ROAD
LAKE FOREST
IL
60045
0
0
0
1
See Remarks (1)
Common Stock
459650
D
Member of a 13(d) group owning more than 10%
(1) The reporting person is a member of a Section 13(d) "group" with other shareholders of ADGF, as described in Amendment
No. 4 to Schedule 13D filed with the Securities and Exchange Commission on November 17, 2011.
/s/ Roland E. Casati
2011-11-28