4 1 kl05022_form4.txt FORM 4 FORM 4 --------------------------- OMB APPROVAL --------------------------- OMB Number........3235-0287 Expires: January 31,2005 Estimated average burden hours per response......0.5 --------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ( ) Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). 1. Name and Address of Reporting Person Cooke, Kim D. c/o Internet Commerce Corporation 805 Third Avenue New York, New York 10022 2. Issuer Name and Ticker or Trading Symbol Internet Commerce Corporation ("ICCA") 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Statement for Month/Year October 2001 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) (X) Director ( ) 10% Owner ( ) Officer (give title below) ( ) Other (specify below) 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 | -----------------------------------------------------------------------------------------------------------------------------------| 1. Title of Security |2. |3. |4.Securities Acquired (A) |5.Amount of |6.Dir |7.Nature of Indirect | | Transaction | or Disposed of (D) | Securities |ect | Beneficial Ownership | | | | | Beneficially |(D)or | | | | | | | A/| | Owned at |Indir | | | Date |Code|V| Amount | D | Price | End of Month |ect(I)| | -----------------------------------------------------------------------------------------------------------------------------------| -----------------------------------------------------------------------------------------------------------------------------------| Class A Common Stock |10/29/01| P | | 181,818 | A | $2.75(1) | 945,455 |I(2) | (1)(2) | -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | -----------------------------------------------------------------------------------------------------------------------------------|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see Instruction 4(b)(v). (Over) SEC 1474 (7-96) Page 1 of 2
----------------------------------------------------------------------------------------------------------------------------------- Table II -- Derivative Securitites Acquired, Disposed of, or Beneficially Owned | -----------------------------------------------------------------------------------------------------------------------------------| 1.Title of Derivative |2.Con- |3. |4. |5.Number of De |6.Date Exer|7.Title and Amount |8.Price|9.Number |10.|11.Nature of | Security |version |Transaction | rivative Secu |cisable and| of Underlying |of Deri|of Deriva |Dir|Indirect | (Instr. 3) |or Exer |(Date/ | rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise |Month/ | red(A) or Dis |Date(Month/| (Instr. 3 and 4) |Secu |Securities |(D)|Ownership | |Price of|Year)| | posed of(D) |Day/Year) | |rity |Benefi |or |(Instr. 4) | |Deriva- |(Instr.8) | (Istr.3,4 |Date |Expir| |(Instr.|ficially |Ind| | |tive | | | and 5) |Exer-|ation| Title Amount or|5) |Owned at |ire| | |Secu- | | | | | D |cisa-|Date | Number | |End of |ct | | |rity |Date |Code|V| Amount | |ble | | of Shares| |Month |(I)| | | | | | | | | | | | |(Instr.4) |(In| | |str| | |4) | | -----------------------------------------------------------------------------------------------------------------------------------| -----------------------------------------------------------------------------------------------------------------------------------| 2001 Private | | | | | | | | |Class A| | | | | | Placement | | | | | | | | |Common | | | | | | Warrant |$3.58 |10/29/01|P | |54,545|A |10/29/01|10/28/06|Stock |54,545 | (1) |54,545(3) | I | (1)(3) | -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | -----------------------------------------------------------------------------------------------------------------------------------|
Explanation of Responses: (1) On October 29, 2001, Blue Water Venture Fund II, L.L.C., of which Mr. Cooke is a managing director., purchased for $2.75 per share of class A common stock, 181,818 shares of class A common stock and 54,545 warrants to purchase class A common stock in a private placement. (2) Mr. Cooke disclaims beneficial ownership as to these securities, which are owned by Blue Water Venture Fund II, L.L.C., of which Mr. Cooke is a managing director. (3) Mr. Cooke disclaims beneficial ownership as to 54,545 of these securities. which are owned by Blue Water Venture Fund II, L.L.C., of which Mr. Cooke is a managing director. /s/ Kim D. Cooke -------------------------------- ** Signature of Reporting Person May 10, 2002 ----------------- 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. 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. SEC 1474 (7-96) Page 2 of 2