-----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, KHTcMjoSuyWNINGDo8RA0NGzo4WmHeSSRIth8JOif/4Vi7gUUbO8+F0j//STGYTF jHZHAmao3Fl9d/5oUE4fxA== 0000950136-01-000254.txt : 20010212 0000950136-01-000254.hdr.sgml : 20010212 ACCESSION NUMBER: 0000950136-01-000254 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20001231 FILED AS OF DATE: 20010209 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: 1530154 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 JOSEPH CENTRAL INDEX KEY: 0001015747 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: C/O CAY HOUSE STREET 2: P O BOX N7776 CITY: LYFORD CAY BAHAMAS BUSINESS PHONE: 2125195182 MAIL ADDRESS: STREET 1: PO BOX N7776 CITY: LYFORD BAHAMAS 4 1 0001.txt 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: September 30, 1998 | Instruction (b). | Estimated average burden | | hours per response....... 0.5 | _________________________________ UNITED STATES 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 - ------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Lewis Joseph - ----------------------------------------------------- (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 December, 2000 - ------------------------------------------------------------------------------- 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) -------------------------------------------------- - ------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Line) [X] Form filed by One Reporting Person [ ] Form filed by More than One Reporting Person - -------------------------------------------------------------------------------
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 Date Code 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, $0.01 par value per share 12/20/00 S 10,000 D $9.75 - --------------------------------------------------------------------------------------------------------------------------------- Common Stock, $0.01 par value per share 12/22/00 S 20,000 D $9.125 1,392,100 I (1) - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------
1 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) - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------
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. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). /s/ Joseph Lewis 2/7/01 ------------------------ ------------------------ **Signature of Reporting Person Date Note: File three copies of this Form, one of which must be manually signed. If space 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. 2 -----END PRIVACY-ENHANCED MESSAGE-----