SEC FORM
3
SEC 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
or Section 30(h) of the Investment Company Act of 1940
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| OMB APPROVAL |
| OMB Number: |
3235-0104 |
| Estimated average burden |
| hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
| C/O ACTIVISION PUBLISHING, INC. |
| 3100 OCEAN PARK BOULEVARD |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year)
10/28/2010
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3. Issuer Name and Ticker or Trading Symbol
Activision Blizzard, Inc.
[ ATVI ]
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
| X |
Officer (give title below) |
|
Other (specify below) |
| Principle Accounting Officer |
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5. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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| Table I - Non-Derivative Securities Beneficially Owned |
|---|
| 1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Common Stock, par value $0.000001 per share |
41,050
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D |
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Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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| Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Employee Stock Options |
01/03/2011 |
01/03/2016 |
Common Stock, par value $0.000001 per share |
16,000 |
6.7 |
D |
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| Employee Stock Options |
|
11/15/2017 |
Common Stock, par value $0.000001 per share |
20,000 |
10.375 |
D |
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| Employee Stock Options |
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08/22/2018 |
Common Stock, par value $0.000001 per share |
110,000 |
16.99 |
D |
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| Employee Stock Options |
|
11/17/2018 |
Common Stock, par value $0.000001 per share |
17,500 |
10.47 |
D |
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| Employee Stock Options |
|
11/09/2019 |
Common Stock, par value $0.000001 per share |
20,000 |
11.54 |
D |
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| Explanation of Responses: |
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| Remarks: |
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|
/s/ Stephen Wereb |
10/29/2010 |
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** Signature of Reporting Person |
Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * If the form is filed by more than one reporting person,
see
Instruction
5
(b)(v). |
| ** 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 is insufficient,
see
Instruction 6 for procedure. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby constitutes and
appoints each of Christopher B.
Walther and Thomas Tippl, signing singly, the undersigned's true and lawful
attorney-in-fact to:
1. execute for and on behalf of the undersigned, in the
undersigned's capacity as an officer or director
of Activision Blizzard, Inc. (the "Company"), Forms 3, 4, and 5 in accordance
with Section 16(a) of
the Securities Exchange Act of 1934 and the rules thereunder;
2. do and perform any and all acts for and on behalf of the
undersigned which may be necessary or
desirable to complete and execute any such Form 3, 4, or 5, complete and
execute any amendment or
amendments thereto, and timely file such form with the United States
Securities and Exchange
Commission and any stock exchange or similar authority; and
3. take any other action of any type whatsoever in connection with
the foregoing which, in the opinion
of such attorney-in-fact, may be of benefit to, in the best interest of, or
legally required by, the
undersigned, it being understood that the documents executed by such
attorney-in-fact on behalf of
the undersigned pursuant to this Power of Attorney shall be in such form and
shall contain such
terms and conditions as such attorney-in-fact may approve in such attorney-
in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any
and every act and thing whatsoever requisite, necessary, or proper to be done
in the exercise of any of the
rights and powers herein granted, as fully to all intents and purposes as the
undersigned might or could do if
personally present, with full power of substitution or revocation, hereby
ratifying and confirming all that such
attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall
lawfully do or cause to be done by
virtue of this power of attorney and the rights and powers herein granted.
The undersigned acknowledges
that the foregoing attorneys-in-fact, in serving in such capacity at the
request of the undersigned, are not
assuming, nor is the Company assuming, any of the undersigned's
responsibilities to comply with Section 16
of the Securities Exchange Act of 1934.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file
Forms 3, 4, and 5 with respect to the undersigned's holdings of and
transactions in securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing
delivered to the foregoing attorneys-
in-fact.
IN WITNESS WHEREOF, the undersigned has caused this power of attorney to be
executed as of this 1st
day of September, 2010.
/s/ S. Wereb__________________
Stephen Wereb
