4 1 f4dje802.txt FORM 4 FORM 4 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: Evans Daniel J. -------------------------------------------------------------------- (Last) (First) (Middle) 1111 Third Avenue, Suite 3400 -------------------------------------------------------------------- (Street) Seattle WA 98101 -------------------------------------------------------------------- (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): -------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable): Director ( X ) Officer (give title below) ( ) 10% Owner ( ) Other (specify below) ( ) --------------------------------------------- 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 08-19-02 P 9,000 A $1.75 ------------------------------------------------------------------------------------------------------------------------- Common Stock 08-20-02 P 7,300 A $1.6856 ------------------------------------------------------------------------------------------------------------------------- Common Stock 08-20-02 P 3,700 A $1.66 61,442 D ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------
*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. (over) FORM 4 (continued)(Daniel J. Evans)
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) -------------------------------------------------------------------------------------------------------------------------- Stock Option $36.875 02-01-00 02-01-03 common 10,000 10,000 D (right to stock buy) -------------------------------------------------------------------------------------------------------------------------- Stock Option $ 3.875 02-01-01 02-01-04 common 10,000 10,000 D (right to stock buy) -------------------------------------------------------------------------------------------------------------------------- Stock Option $ 2.10 (1) 06-24-06 common 10,000 10,000 D (right to stock buy) -------------------------------------------------------------------------------------------------------------------------- Employee $ 1.67 (2) 07-23-05 common 30,000 30,000 D Stock Option stock (right to buy) -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- Explanation of Responses: (1) The option vests in four equal installments beginning on June 25, 2002. (2) The option vests in two equal annual installments, beginning on July 23, 2003.
/s/ DANIEL J. EVANS 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 2