U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549
FORM 5
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 this box if no longer subject of Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
|X| Form 3 Holdings Reported
|_| Form 4 Transactions Reported
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1. Name and Address of Reporting Person*
Artemis America Partnership
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(Last) (First) (Middle)
c/o RL&F Services Corporation
One Rodney Square
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(Street)
Wilmington, DE 19801
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Converse, Inc. [CVEO]
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
12/00
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
|_| Director |X| 10% Owner
|_| Officer (give title below) |_| Other (specify below)
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7. Individual or Joint/Group Filing (Check Applicable Line)
|_| Form filed by One Reporting Person
|X| Form filed by More than One Reporting Person
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* If the Form is filed by more than one Reporting Person, see Instruction
4(b)(v).
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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5. 6.
4. Amount of Owner-
Security Acquired (A) or Securities ship
Disposed of (D) Beneficially Form: 7.
(Instr. 3, 4 and 5) Owned at End Direct Nature of
2. 3. ----------------------------- of Issuer's (D) or Indirect
1. Transaction Transaction (A) Fiscal Year Indirect Beneficial
Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4)
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Common Stock, without par value 6/30/00 J(1) 5,614,054(1) A N/A(1) 5,614,054 D
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Explanation of Responses:
(1) Shares were transferred to Artemis America Partnership ("Artemis") in
connection with the transfer to Artemis of voting rights previously beneficially
held by Lion Advisors, L.P. in a managed account on behalf of Artemis.
/s/ Emmanuel Cueff February 15, 2001
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**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.
Joint Filer Information
Name: Artemis Finance SNC
Address: 5 Boulevard de Latour Maubourg
75007, Paris, France
Designated Filer: Artemis America Partnership (1)(2)
Issuer & Ticker Symbol: Converse Inc. ("CVEO")
Date of Event
Requiring Statement: June 30, 2000
Signature: /s/ Emmanuel Cueff Date: February 15, 2001
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Name: Emmanuel Cueff
Title: General Secretary of Artemis Finance SNC
Joint Filer Information
Name: Artemis SA
Address: 5 Boulevard de Latour Maubourg
75007, Paris, France
Designated Filer: Artemis America Partnership (1)
Issuer & Ticker Symbol: Converse Inc. ("CVEO")
Date of Event
Requiring Statement: June 30, 2000
Signature: /s/ Emmanuel Cueff Date: February 15, 2001
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Name: Emmanuel Cueff
Title: General Secretary of Artemis SA
(1) Artemis SA and Artemis Finance SNC are general partners of Artemis America
Partnership.
(2) The Managing General Partner of Artemis Finance SNC is Artemis SA.