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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES 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(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
FRASER JEFFERY S C/O NIC INC. 10540 SOUTH RIDGEVEIW ROAD OLATHE, KS 66061 |
X | X | Chairman & CEO |
Stephen M. Kovzan, Attorney-in-Fact | 01/31/2005 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Distribution to the Reporting Person from the National Information Consortium Voting Trust. |
(2) | The Reporting Person also indirectly owns: (i) 17,550,257 shares of NIC common stock which are held directly by the National Information Consortium Voting Trust ("Voting Trust"), which holds in the aggregate 23,490,805 shares & indirectly by the Reporting Person as one of the Trustees of the Voting Trust; and (ii) 5,940,548 shares of NIC held of record by the Voting Trust for the benefit of entities of which the Reporting Person acts as a manager; however, the Reporting Person disclaims beneficial ownership over 2,589,194 of the shares of NIC held by one entity. |
(3) | The Reporting Person also directly owns employee stock options to purchase NIC Inc. common stock: (i) 77,043 shares at $2.57 per share, exercisable in two equal annual installments, beginning on May 14, 2004, (ii) 150,000 shares at $3.34 per share, exercisable in four equal annual installments, beginning August 1, 2004, and (iii) 20,000 shares at $7.67 per share, exercisable in four equal annual installments, beginning on November 10, 2004, and (iv) 25,000 shares at $4.15 per share, exercisable in four equal annual installments, beginning on November 5, 2005. |