-----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, EBbpwgerQDzd8cM8GNOsxxPoTHowjr7uGWgDaHttGwrXVjFSFfAcy3ZEmkjaam2T 6cJ0GBZwg+6CYPxc+KY5yw== 0001017951-02-000196.txt : 20020830 0001017951-02-000196.hdr.sgml : 20020830 20020829180132 ACCESSION NUMBER: 0001017951-02-000196 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020827 FILED AS OF DATE: 20020830 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: NIC INC CENTRAL INDEX KEY: 0001065332 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 522077581 STATE OF INCORPORATION: CO FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-26621 FILM NUMBER: 02753284 BUSINESS ADDRESS: STREET 1: 12 CORPORATE WOODS 10975 BENSON STREET STREET 2: SUITE 390 CITY: OVERLAND PARK STATE: KS ZIP: 66210 MAIL ADDRESS: STREET 1: 12 CORPORATE WOODS 10975 BENSON STREET STREET 2: SUITE 390 CITY: OVERLAND PARK STATE: KS ZIP: 66210 FORMER COMPANY: FORMER CONFORMED NAME: NATIONAL INFORMATION CONSORTIUM INC DATE OF NAME CHANGE: 19990504 FORMER COMPANY: FORMER CONFORMED NAME: NATIONAL INFORMATION CONSORTIUM DATE OF NAME CHANGE: 19990618 COMPANY DATA: COMPANY CONFORMED NAME: FRASER JEFFERY S CENTRAL INDEX KEY: 0001106139 DIRECTOR FILING VALUES: FORM TYPE: 4/A BUSINESS ADDRESS: STREET 1: P.O. BOX 4919 CITY: JACKSON STATE: WY ZIP: 83001 BUSINESS PHONE: 3077347140 4/A 1 f4ajf802.txt AMENDMENT NO. 1 TO FORM 4 FORM 4/A U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 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 to Section 16. Form 4 or Form 5 obligations may continue. SEE Instruction 1(b). 1. Name and Address of Reporting Person: Fraser Jeffery S. -------------------------------------------------------------------- (Last) (First) (Middle) c/o National Information Consortium, Inc. 12 Corporate Woods 10975 Benson Street, Suite 390 -------------------------------------------------------------------- (Street) Overland Park KS 66210 -------------------------------------------------------------------- (City) (State) (Zip) 2. Issuer Name and Ticker or Trading Symbol: NIC Inc. (EGOV) -------------------------------------------------------------------- 3. IRS or Social Security Number of Reporting Person (Voluntary): -------------------------------------------------------------------- 4. Statement for Month/Year: August 2002 -------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year): August 2002 -------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable): Director ( X ) Officer (give title below) ( X ) 10% Owner ( X ) Other (specify below) ( ) President and Chief Executive Officer --------------------------------------------- 7. Individual or Joint/Group Filing (Check Applicable Line) Form filed by One Reporting Person ( X ) Form filed by More than One Reporting Person ( )
TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - -------------------------------------------------------------------------------------------------------------------- 3. 4. 5. 6. 7. Transaction Securities Acquired (A) or Amount of Ownership Nature Code Disposed of (D) Securities Form: of 2. (Instr. 8) (Instr. 3, 4 and 5) Beneficially Direct (D) Indirect Transaction ----------- -------------------------- Owned at End or Beneficial 1. Date (A) of Month Indirect (I) Ownership Title of Security (Month/ Amount Or Price (Instr. 3 (Instr. 4) (Inst. 4) (Instr. 3): Day/Year) Code V (D) & 4 - ------------------------------------------------------------------------------------------------------------------------- Common Stock 21,057,699 I (1) - ------------------------------------------------------------------------------------------------------------------------- Common Stock 08/06/01 J(6) 15,691 A N/A 6,100,117 I (2) - ------------------------------------------------------------------------------------------------------------------------- Common Stock 08/06/01 J(6) 802 A N/A 312,068 I (3) - ------------------------------------------------------------------------------------------------------------------------- See Attached Schedule - ------------------------------------------------------------------------------------------------------------------------- Common Stock 150,000 I (5) - -------------------------------------------------------------------------------------------------------------------------
*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 or indirectly. 1 of 3 Name of Reporting Person: Jeffery S. Fraser Issuer Name and Ticker or Trading Symbol: NIC Inc. (EGOV) Statement for Month/Year: August 2002
TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - -------------------------------------------------------------------------------------------------------------------- 3. 4. 5. 6. 7. Transaction Securities Acquired (A) or Amount of Ownership Nature Code Disposed of (D) Securities Form: of 2. (Instr. 8) (Instr. 3, 4 and 5) Beneficially Direct (D) Indirect Transaction ----------- -------------------------- Owned at End or Beneficial 1. Date (A) of Month Indirect (I) Ownership Title of Security (Month/ Amount Or Price (Instr. 3 (Instr. 4) (Inst. 4) (Instr. 3): Day/Year) Code V (D) & 4 - ------------------------------------------------------------------------------------------------------------------------- Common Stock 08-06-02 P 2,000 A $1.71 - ------------------------------------------------------------------------------------------------------------------------- Common Stock 08-07-02 P 13,500 A $1.69 - ------------------------------------------------------------------------------------------------------------------------- Common Stock 08-07-02 P 50,000 A $1.70 - ------------------------------------------------------------------------------------------------------------------------- Common Stock 08-09-02 P 5,000 A $1.70 - ------------------------------------------------------------------------------------------------------------------------- Common Stock 08-12-02 P 10,000 A $1.70 - ------------------------------------------------------------------------------------------------------------------------- Common Stock 08-13-02 P 19,500 A $1.6479 - ------------------------------------------------------------------------------------------------------------------------- Common Stock 08-27-02 P 50,000 A $1.70 - -------------------------------------------------------------------------------------------------------------------------
2 of 3 FORM 4/A (continued)(Jeffery S. Fraser)
TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities) - -------------------------------------------------------------------------------------------------------------------------- 9. 10. 11. Number Owner- Nature of ship of 2. Deriv- Form In- Conver- 5. 7. ative of direct sion Number of Title and Amount Secur- Deriv- Bene- or Derivative 6. of Underlying 8. ities ative Ficial Exer- Securities Date Securities Price Bene- Secu- Owner- cise 3. 4. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially rity: ship Price Trans- Trans- or Disposed Expiration Date ---------------- Deriv- Owned Direct (Instr. 1. of action action of (D) (Month/Day/Year) Amount ative at End (D) or 4) Title of Deriv- Date Code (Instr.3, ---------------- or Secur- of Indirect) Derivative ative (Month/ (Instr. 4 and 5) Date Expira- Number ity Month (I) Security Secur- Day/ 8) . ---------- Exer- tion of (Instr. (Instr. Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) - -------------------------------------------------------------------------------------------------------------------------- Employee $1.67 (4) 07-23-05 common 60,000 60,000 D Stock Option stock (right to buy) - -------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) These shares are held directly by the National Information Consortium Voting Trust, which holds in the aggregate 27,469,884 shares, and indirectly by Mr. Fraser as one of the trustees of the trust. Mr. Fraser is the President, Chief Executive Officer, a director and a 10% owner of the issuer. (2) These shares are held directly by the National Information Consortium Voting Trust, for which Mr. Fraser acts as one of the trustees, for his benefit as a direct beneficiary of the trust. (3) These shares are held directly by the National Information Consortium Voting Trust, for which Mr. Fraser acts as one of the trustees, for the direct benefit of the Crimson Tide Charitable Remainder Unitrust, of which Mr. Fraser acts as trustee. (4) The option vests in two equal annual installments, beginning on July 23, 2003. (5) These shares are held directly by the Fraser Family Trust, and indirectly by Mr. Fraser as one of the trustees of the trust. (6) In 2001, the National Information Voting Trust repurchased units of the trust which beneficially owned 70,686 shares of the issuer. The repurchased units (and beneficial ownership of the underlying shares of the issuer) were distributed pro rata among the remaining beneficial owners of the trust.
/s/ JEFFERY S. FRASER August 29, 2002 - ---------------------------------- ------------------- **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. Page 3 of 3 -----END PRIVACY-ENHANCED MESSAGE-----