1 - -------- FORM 3 - -------- U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, DC 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
- ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name and Ticker or 6. If Amendment, Date Savoy William D. Statement Trading Symbol of Original - ---------------------------------------- (Month/Day/Year) HSN, Inc. (HSNI) (Month/Day/Year) (Last) (First) (Middle) 7/17/97 ---------------------------------- 110 110th Avenue, N.E., #550 ---------------------------- 5. Relationship of Reporting ----------------------- - ---------------------------------------- 3. IRS or Social Security Person to Issuer 7. Individual or Joint/ (Street) Number of Reporting (Check all applicable) Group Filing (Check Bellevue WA 98004 Person (Voluntary) X Director 10% Owner applicable line) - -------------------------------------- ----- ----- X Form filed by (City) (State) (Zip) ---------------------------- Officer Other ----- One Reporting ----- (give ----- (specify Person title below) below) Form filed by ----- More than One ---------------------------------- Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership Form: 4. Nature of Indirect (Instr. 4) Beneficially Owned Direct (D) or Beneficial (Instr. 4) Indirect (I) Ownership (Instr. 4) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 14,500 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. (Over) (Print or Type Responses) (8/96) 2
FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 2. Date 3. Title and Amount of 4. Conver- 5. Owner- 6. Nature of Indirect (Instr. 4) Exercisable and Securities Underlying sion or ship Beneficial Ownership Expiration Date Derivative Security Exercise Form of (Instr. 5) (Month/Day/ (Instr. 4) Price of Deriv- Year) Deri- ative vative Security: Security ------------------------------------------------- Direct Date Expira- Amount or (D) or Exercis- tion Title Number Indirect (I) able Date of Shares (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: /s/ WILLIAM D. SAVOY July 24, 1997 **Intentional misstatements or omissions of facts constitute Federal Criminal ------------------------------- ------------------ Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date Note. File three copies of this form, one of which must be manually signed. Page 2 If space provided is insufficient, See Instruction 6 for procedure. (8/96) (Print or Type Responses)