-----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, CaD8zJAiT/Wn2e3tjAjWMQ6h9EUBYA0uoUY5lM8NJTxZumw2enNjulLypP3ElVRa 40KwNLezsPgfly1a9Eoz9Q== 0000922423-02-001032.txt : 20020913 0000922423-02-001032.hdr.sgml : 20020913 20020913164150 ACCESSION NUMBER: 0000922423-02-001032 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020901 FILED AS OF DATE: 20020913 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INTERNET COMMERCE CORP CENTRAL INDEX KEY: 0000894738 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING SERVICES [7371] IRS NUMBER: 133645702 STATE OF INCORPORATION: DE FISCAL YEAR END: 0731 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24996 FILM NUMBER: 02764037 BUSINESS ADDRESS: STREET 1: 805 THIRD AVE STREET 2: STE 622 CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2122717640 MAIL ADDRESS: STREET 1: 805 THIRD AVENUE STREET 2: 342 MADISON AVENUE CITY: NEW YORK STATE: NY ZIP: 10022 FORMER COMPANY: FORMER CONFORMED NAME: INFOSAFE SYSTEMS INC DATE OF NAME CHANGE: 19940914 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: HUBBARD DAVID CENTRAL INDEX KEY: 0001102311 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: C/O INTERNET COMMERCE CORP STREET 2: 805 THIRD AVE CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 2122717640 MAIL ADDRESS: STREET 1: C/O INTERNET COMMERCE CORP STREET 2: 805 THIRD AVE CITY: NEW YORK STATE: NY ZIP: 10022 5 1 kl09033_form5.txt FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 5 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |_| Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |_| Form 3 Holdings Reported |_| Form 4 Transactions Reported 1. Name and Address of Reporting Person Hubbard, David c/o Internet Commerce Corporation 905 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 09/02 5. If Amendment, Date of Original (Month/Year) 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) ( ) Director ( ) 10% Owner (X) Officer (give title below) ( ) Other (specify below) Chief Technology Officer 7. Individual or Joint/Group Reporting (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 | |Date |Code| (Instr.3,4 and 5) | Beneficially |(D)or | (Instr. 4) | | |(Ins| | A/| | Owned at |Indir | | | |tr.8) Amount | D | Price | End of Year |ect(I)| | | | | | | (Instr. 3 and 4) |(Ins | | | | | | | | tr.4)| | - -----------------------------------------------------------------------------------------------------------------------------------| None | | | | | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. *If form is filed by more than one reporting person, see instruction 4(b)(v). (Over) SEC 2270(7-96) FORM 5 (continued) Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
- ----------------------------------------------------------------------------------------------------------------------------------- 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 | |or Exer |Date |Code| rities Acqui |Expiration | Securities |vative |tive |ect|Beneficial | |cise Pr | |(In | red(A) or Dis |Date(Month/| (Instr. 3 and 4 |Secu |Securities |(D)|Ownership | |ice of | |str.| posed of(D) |Day/Year) | |rity |Benefi |or | | |Deriva | | 8) | (Instr.3,4 and|Date |Expir| |(Instr.|ficially |Ind| | |tive | | | 5) | |Exer-|ation| Title and Number | 5) |Owned at |ire| | |Secu | | | | |cisa-|Date | of Shares | |End of |ct | | |rity | | | A | D |ble | | | |Year |(I)| | | | | | | | | | | |(Instr. 4) |(Instr. 4) | - -----------------------------------------------------------------------------------------------------------------------------------| Stock Option |$2.70 |5/10/|A(1)| 110,000 | | (2) |5/10/|Class A |110,000| | 110,000 | D | | (Right to Buy) | |02 | | | | |12 |Common | | | | | | | | | | | | | |Stock | | | | | | | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| Stock Option | | | | | | | | | | | 113,930 | D | | (Right to Buy) | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | - -----------------------------------------------------------------------------------------------------------------------------------|
Explanation of Responses: (1) Granted pursuant to the Company's Amended and Restated Stock Option Plan. (2) One third (1/3) of the options are exercisable on the grant date. One third (1/3) of the options vest and become exercisable when the Company's class A common stock closes at a price per share of $10.00. One third (1/3) of the options vest and become exercisable when the Company's net revenues in any one month equal or exceed $2 million. The foregoing notwithstanding, all options vest and become exercisable in full on November 10, 2007 or upon a change of control of the Company. /s/ David Hubbard September 13, 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. 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. -2- -----END PRIVACY-ENHANCED MESSAGE-----