-----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, Oa4WvL292FYKeFXahuiRFW/k9zyKz5rT7p33eYNaTY5DYevgNknAZQqcGcxsoO5v RmpH9a8WRT5waBuFZVPauw== 0000950136-99-001608.txt : 19991228 0000950136-99-001608.hdr.sgml : 19991228 ACCESSION NUMBER: 0000950136-99-001608 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991216 FILED AS OF DATE: 19991227 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: 3 SEC ACT: SEC FILE NUMBER: 001-15007 FILM NUMBER: 99780894 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: MANDARIN INC CENTRAL INDEX KEY: 0001015748 STANDARD INDUSTRIAL CLASSIFICATION: [] OWNER FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 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 3 1 FORM 3 FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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* Mandarin, Inc. - ----------------------------------------------------------- (Last) (First) (Middle) c/o Cay House P.O. Box N7776 - ----------------------------------------------------------- (Street) Lyford Cay, New Providence, Bahamas - ----------------------------------------------------------- (City) (State) (Zip) - ------------------------------------------------------------------------------- 2. Date of Event Requiring Statement (Month/Day/Year) 12/16/99 - ------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) - ------------------------------------------------------------------------------- 4. Issuer Name and Ticker of Trading Symbol Dave & Busters, Inc./DAB - ------------------------------------------------------------------------------- 5. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [X] 10% Owner [ ] Officer (give title below) [ ] Other (specify below) -------------------------------------------------- - ------------------------------------------------------------------------------- 6. If Amendment, Date of Original (Month/Day/Year) - ------------------------------------------------------------------------------- 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 3 (continued)
TABLE I--Non-Derivative Securities Beneficially Owned - -------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Amount of Securities 3. Ownership 4. Nature of Indirect Beneficial Onwership (Instr. 4) Beneficially Owned Form: Direct (Instr. 4) (Instr. 4) (D) or Indirect (I) (Instr. 5) - -------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------- Common Stock 1,342,600 D - -------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------
*If the Form is filed by more than one Reporting Person, see Instruction 5(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. Page 2 FORM 3 (continued)
TABLE II--Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) - ---------------------------------------------------------------------------------------------------------------------------------- 1. Title of Derivative 2. Date Exer- 3. Title and Amount of Securities 4. Conver- 5. Owner- 6. Nature of Security (Instr. 4) cisable and Underlying Derivative Security sion or ship Indirect Expiration (Instr. 4) Exercise Form of Beneficial Date ----------------------------------- Price of Deriv- Ownership (Month/Day/Year) Deriv- ative (Instr. 5) --------------------- Amount ative Security or Security Direct Date Expira- Title Number (D) or Exer- tion of Indirect cisable Date Shares (I) (Instr. 5) - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- Put (Obligation to buy) currently 2/2000 Common Stock 50,000 12.5 D exercisable - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: ** 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. Mandarin, Inc. /s/ Joseph Lewis 12/27/99 ---------------------------------------- ------------------ ** Signature of Reporting Person Date Page 3 -----END PRIVACY-ENHANCED MESSAGE-----