Form 5 - Steven T. Mayer - 3/31/01
FORM 5
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
[ ] Check box if no longer subject to Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
[ ] Form 3 Holdings Reported
[ ] Form 4 Transactions Reported
1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person
to Issuer (Check all applicable)
Mayer Steven T. Activision, Inc. (ATVI)
__________________________________________ _____________________________________________ X Director 10% Owner
--- ---
(Last) (First) (Middle) 3. IRS Identification 4. Statement for Officer (give Other (Specify
Number of Reporting Month/Year --- title below) --- below)
c/o Activision, Inc. Person, if an Entity
3100 Ocean Park Boulevard (Voluntary) March 31, 2001
__________________________________________ ______________________________________________________________
(Street)
5. If Amendment, Date of 7. Individual or Joint/Group Reporting
Santa Monica California 90405 Original (Month/Year) (Check applicable line)
__________________________________________ _X_ Form Filed by One Reporting Person
(City) (State) (Zip) Form Filed by More than One
--- Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
5. Amount of
Securi-
ties
Bene-
ficially
4. Securities Acquired (A) Owned at 6. Ownership
2. Trans- 3. Trans- or Disposed of (D) End of Form:
action action (Instr. 3, 4 and 5) Issuer's Direct 7. Nature of
Date Code --------------------------- Fiscal (D) or Indirect
Month/ (Instr. 8) (A) Year Indirect Beneficial
1. Title of Security Day/ Amount or Price (Instr. (I) Ownership
(Instr.3) Year) (D) 3 and 4) (Instr. 4) (Instr. 4)
----------------------------- --------- ---------- -------- --- -------- ------------ ------------- -------------
5,861 D
Common Stock, par value
$.000001 per share
* If the form is filed by more than one reporting person, see instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities
beneficially owned directly of indirectly.
(Print or Type Responses) (Over)
SEC 2270 (7/96)
FORM 5 (continued)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
2. Conver- 5. Number of Deriv- 6. Date Exercisable
sion or 3. Trans- ative Securities and Expiration Date
Exercise action Acquired (A) or (Month/Day/Year)
Price of Date 4. Trans- Disposed of (D) -----------------------
Deriv- (Month/ action (Instr. 3, 4, and 5) Date
1. Title of Derivative Security ative Day/ Code ----------------------- Exercis- Expiration
(Instr. 3) Security Year) (Instr. 8) A D able Date
---------------------------------- ----------- ---------- ------------ ----------- ----------- ---------- ----------
Director Stock Options $9.50 6/4/98 A5 15,000 6/4/99(1) 6/4/08
Director Stock Options $11.50 12/11/98 A5 20,000 12/11/99(2) 12/11/08
9. Number of 10. Ownership
Derivative of
7. Title and Amount of Underlying Securities Derivative
Securities (Instr. 3 and 4) Beneficially Security: 11. Nature of
--------------------------------- 8. Price of Owned Direct (D) Indirect
Amount or Derivative at End or Beneficial
1. Title of Derivative Title Number of Security of Year Indirect (I) Ownership
Security (Instr. 3) Shares (Instr. 5) (Instr. 4) (Instr. 4) (Instr. 4)
---------------------- -------------------- --------- ------------- ------------- -------------- --------------
Director Stock Options Common Stock 15,000
Director Stock Options Common Stock 20,000 121,667(3) D
Explanation of Responses:
(1) The options vested in two equal annual installments beginning on 6/4/99.
(2) The options vest in five equal annual installments beginning on 12/11/99.
(3) The warrants previously reported as covering 500,000 shares at an exercise price
of $.025 per share were adjusted to reflect a 1-for-10 reverse stock split on
August 3, 1992 and a 1-for-3 reverse stock split on October 20, 1993, resulting
in warrants covering 16,667 shares at an exercise price of $0.75 per share.
/s/ Steven Mayer 5/3/01
**Intentional misstatements or omissions of facts constitute ------------------------------- --------------
Federal Criminal Violations. See 18 U.S.C. 1001 and **Signature of Reporting Person Date
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.
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