-----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, O33HZlm3QNOzFKipFSK1u4PqMRTdGHtdkeP9jOEwO0EqWE6sQNpq9RT+BouWQfQr CxQl07RMHw9AWvyJpjqtqw== 0000950136-00-000018.txt : 20000202 0000950136-00-000018.hdr.sgml : 20000202 ACCESSION NUMBER: 0000950136-00-000018 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: DAVE & BUSTERS INC CENTRAL INDEX KEY: 0000943823 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-EATING PLACES [5812] IRS NUMBER: 431532756 STATE OF INCORPORATION: MO FISCAL YEAR END: 0131 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 001-15007 FILM NUMBER: 503855 BUSINESS ADDRESS: STREET 1: 2481 MANANA DRIVE CITY: DALLAS STATE: TX ZIP: 75220 BUSINESS PHONE: 2143579588 MAIL ADDRESS: STREET 1: 2481 MANANA DR CITY: DALLAS STATE: TX ZIP: 75220 COMPANY DATA: COMPANY CONFORMED NAME: LEWIS JANE CENTRAL INDEX KEY: 0001015746 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: C/O CAY HOUSE STREET 2: PO BOX N7776 CITY: LYFORD CAY BAHAMAS BUSINESS PHONE: 2125195182 MAIL ADDRESS: STREET 1: PO BOX N7776 STREET 2: C/O CAY HOUSE CITY: LYFORD BAHAMAS 4 1 FORM 4 FORM 4 ---------------------------------- OMB APPROVAL [ ] Check this box if no longer subject ---------------------------------- to Section 16. Form 4 or Form 5 OMB Number: 3235-0287 obligations may continue. See Expires: April 30, 1997 Instruction 1(b). Estimated average burden hours per response....... 0.5 ---------------------------------- U.S. 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(f) of the Investment Company Act of 1940 (Print or Type Responses) - ------------------------------------------------------------------------------- 1. Name and Address of Reporting Person Lewis Jane - ----------------------------------------------------- (Last) (First) (Middle) c/o Cay House, P.O. Box N7776 - ----------------------------------------------------- (Street) Lyford Cay, New Providence, Bahamas - ----------------------------------------------------- (City) (State) (Zip) - ------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Dave & Busters, Inc. (DAB) - ------------------------------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary) - ------------------------------------------------------------------------------- 4. Statement for Month/Year 12/1999 - ------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) - ------------------------------------------------------------------------------- 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [ ] Director [X] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) -------------------------------------------------- - -------------------------------------------------------------------------------
TABLE I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned - --------------------------------------------------------------------------------------------------------------------------------- 5. Amount of 6. Owner- Securities ship 2. Trans- 3. Trans- 4. Securities Acquired (A) Beneficially Form: action action or Disposed of (D) Owned at Direct 7. Nature of Date Code (Instr. 3, 4 and 5) End of (D) or Indirect 1. Title of Security (Month/ (Instr. 8) -------------------------- Month Indirect Beneficial (Instr. 3) Day/ ---------- Amount (A) or Price (Instr. (I) Ownership Year) Code V (D) 3 and 4) (Instr. 4) (Instr. 4) - --------------------------------------------------------------------------------------------------------------------------------- Common Stock 12/20/99 P 29,500 A $6.1928 1,372,100 I (1) - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (over)
FORM 4 (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 Form of Derivative cisable and Underlying Number of Deriv- Securities Expiration Securities Price Derivative ative Conver- Trans- Acquired (A) Date (Month/ (Instr. 3 of Securities Security: sion or Trans- action or Disposed Day/Year) and 4) Deriv- Benefi- Direct Exercise action Code of (D) -------------- -------------- ative cially (D) or Nature of Title of Price of Date (Instr. (Instr. 3, Date Amount Secur- Owned at Indirect Indirect Derivative Deriv- (Month/ 8) 4 and 5) Exer- Expir- or Num- ity End of (I) Beneficial Security ative Day/ -------- ---------- cis- ation ber of (Instr. Month (Instr. Ownership (Instr. 3) Security Year) Code V (A) (D) able Date Title Shares 5) (Instr. 4) 4) (Instr. 4) - ----------------------------------------------------------------------------------------------------------------------------------- Put Options $5 12/21/99 S 300 (2) 5/2000 Common 30,000 7/8 300 I (1) (Obligation Stock to buy) - ----------------------------------------------------------------------------------------------------------------------------------- Put 12.5 500 (2) 2/00 Common 50,000 500 I (1) (Obligation Stock to buy)(3) - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: (1) The securities reported herein are held by Mandarin, Inc. Joseph Lewis and Jane Lewis are the shareholders and directors of Mandarin, Inc. This filing shall not be deemed an admission that the Reporting Person is, for the purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of any securities covered by this statement. The entire amount of Mandarin, Inc.'s holdings is reported herein. (2) Currently exercisable. (3) Previously reported. /s/ Jane Lewis 1/7/00 ---------------------------------------- -------------------- ** 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. -----END PRIVACY-ENHANCED MESSAGE-----