-----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, WaXfiCHDOyI1/f5MDd1G0L4VYASuOZFWxrBhqe+AqK+Vvgqd4wmxMIPVdzIDuwDJ d4A7FMWF9UeextSArk+9sw== 0001177651-02-000140.txt : 20020906 0001177651-02-000140.hdr.sgml : 20020906 20020906154410 ACCESSION NUMBER: 0001177651-02-000140 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020905 FILED AS OF DATE: 20020906 COMPANY DATA: COMPANY CONFORMED NAME: MANDELBAUM FRANK CENTRAL INDEX KEY: 0001099377 DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: INTELLICHECK INC STREET 2: 775 PARK AVE CITY: HUNTINGTON STATE: NY ZIP: 11743 BUSINESS PHONE: 5164212011 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INTELLI CHECK INC CENTRAL INDEX KEY: 0001040896 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 113234779 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15465 FILM NUMBER: 02758602 BUSINESS ADDRESS: STREET 1: 775 PARK AVE CITY: HUNTINGTON STATE: NY ZIP: 11743 BUSINESS PHONE: 5164212011 MAIL ADDRESS: STREET 1: 775 PARK AVENUE STREET 2: SUITE 340 CITY: HUNTINGTON STATE: NY ZIP: 11743 4 1 doc1.txt U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 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). ________________________________________________________________________________ 1. Name and Address of Reporting Person* Mandelbaum Frank - -------------------------------------------------------------------------------- (Last) (First) (Middle) 246 Crossways Park West - -------------------------------------------------------------------------------- (Street) Woodbury New York 11797 - -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Intelli-Check, Inc. (IDN) ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year September 5, 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 10% Owner [X] Officer (give title below) [ ] Other (specify below) Title if applicable: Chairman & Chief Executive Officer ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [ ] Form filed by more than one Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================
6. 4. 5. Owner- Securities Acquired (A) Amount of ship 3. or Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------ Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) - ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, $.01 par value 09/04/02* S 500 D $3.30 09/05/02* S 500 D $3.05 564,300 D 24,900 I** =================================================================================================================================== *These sales were made by Prudential Securities Incorporated as Pledgee of Mr. Mandelbaum's shares. **These shares are owned by Mr. Mandelbaum's spouse. Mr. Mandelbaum disclaims beneficial ownership of these shares.
FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
=================================================================================================================================== 10. 9. Owner- Number ship of Form 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- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ---------- Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V A D cisable Date Title Shares 5) 4) 4) 4) - ----------------------------------------------------------------------------------------------------------------------------------- 09/04/02 & Rights+ 09/05/02 D 100 Option Common (Right to Buy) $12.10 02/01/02 A 350,000 ** 02/01/07 Stock 350,000 Common Rights* $8.50 12/31/01 A 2,490 Current 10/04/02 Stock 2,490 Option Common (Right to Buy) $3.00 A 25,000 01/01/05 01/01/05 Stock 25,000 I Rights $8.50 12/19/01 A 1000 Common Rights $8.50 12/13/01 A 58,000 Current 10/04/02 Stock 58,000 Common Rights $8.50 10/05/01 A 48,050 Current 10/04/02 Stock 48,050 Option Common (Right to Buy) $3.00 A 25,000 01/01/01 01/01/05 Stock 25,000 Option Common (Right to Buy) $3.00 A 25,000 01/01/00 01/01/05 Stock 25,000 Option Common (Right to Buy) $3.00 A 50,000 Current 09/04/03 Stock 50,000 Option Common (Right to Buy) $3.00 A 375,000 Current 07/15/04 Stock 375,000 2,490* I 956,000 D =================================================================================================================================== Explanation of Responses: * These right attach the shares owned by Mr. Mandelbaum's spouse. Mr. Mandelbaum disclaims beneficial ownership of these rights and the shares underlying them upon a transfer of shares to which the rights are no longer exercisable. ** Of these options, 125,000 which were granted pursuant to the Issuer's 2001 Stock Option Plan are immediately exercisable. Of the remaining 225,000 options, which are non-plan options, an additional 75,000 options will become exercisable on December 31 of each of the 2002, 2003 and 2004. *** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). By: /s/ Frank Mandelbaum Sept. 6, 2002 -------------------------------- --------------- ***Signature of Reporting Person Date Frank Mandelbaum
+The disposal of these rights was due to sales of shares by prudential Securities Incorporated as Pledgee of Mr. Mandelbaum's shares Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. -----END PRIVACY-ENHANCED MESSAGE-----