4 1 doc1.txt U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 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 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* Mandelbaum Frank -------------------------------------------------------------------------------- (Last) (First) (Middle) 246 Crossways Park West ------------------------------------------------------------------------------- (Street) Woodbury New York 11797 ------------------------------------------------------------------------------- (City) (State) (Zip) _______________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Intelli-Check, Inc. (IDN) _______________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) _______________________________________________________________________________ 4. Statement for Month/Year December 16, 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 10% Owner [X] Officer (give title below) [ ] Other (specify below) Title if applicable: Chairman & Chief Executive Officer ________________________________________________________________________________ 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 ================================================================================
6. 4. 5. Owner- Securities Acquired (A) Amount of ship 3. or Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. Code ------------------------------ Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, $.01 par value 12/16/02 G V 3,000 D ----------------------------------------------------------------------------------------------------------------------------------- 525,300 D ----------------------------------------------------------------------------------------------------------------------------------- 24,900 I** =================================================================================================================================== *These sales were made by Prudential Securities Incorporated as Pledgee of Mr. Mandelbaum's shares. **These shares are owned by Mr. Mandelbaum's spouse. Mr. Mandelbaum disclaims beneficial ownership of these shares.
FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
=================================================================================================================================== 10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ---------- Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V A D cisable Date Title Shares 5) 4) 4) 4) ----------------------------------------------------------------------------------------------------------------------------------- Rights+ 12/16/02 D V 300 ----------------------------------------------------------------------------------------------------------------------------------- Option Common (Right to Buy) $12.10 02/01/02 A 350,000 ** 02/01/07 Stock 350,000 ----------------------------------------------------------------------------------------------------------------------------------- Common Rights* $8.50 12/13/01 A 2,490 Current 04/04/03 Stock 2,490 ----------------------------------------------------------------------------------------------------------------------------------- Option Common (Right to Buy) $3.00 A 25,000 01/01/02 01/01/05 Stock 25,000 ----------------------------------------------------------------------------------------------------------------------------------- Rights $8.50 12/13/01 A 58,000 Current 04/04/03 Common 58,000 ----------------------------------------------------------------------------------------------------------------------------------- Common Rights $8.50 10/05/01 A 44,100++ Current 04/04/03 Stock 44,100++ ----------------------------------------------------------------------------------------------------------------------------------- Option Common (Right to Buy) $3.00 A 25,000 01/01/01 01/01/05 Stock 25,000 ----------------------------------------------------------------------------------------------------------------------------------- Option Common (Right to Buy) $3.00 A 25,000 01/01/00 01/01/05 Stock 25,000 ----------------------------------------------------------------------------------------------------------------------------------- Option Common (Right to Buy) $3.00 A 50,000 Current 09/04/03 Stock 50,000 ----------------------------------------------------------------------------------------------------------------------------------- Option Common (Right to Buy) $3.00 A 375,000 Current 07/15/04 Stock 375,000 ----------------------------------------------------------------------------------------------------------------------------------- 2,490* I 952,100 D =================================================================================================================================== Explanation of Responses: * These rights attach the shares owned by Mr. Mandelbaum's spouse. Mr. Mandelbaum disclaims beneficial ownership of these rights and the shares underlying them. Upon a transfer of shares to which the rights are no longer exercisable. ** Of these options, 125,000 which were granted pursuant to the Issuer's 2001 Stock Option Plan are immediately exercisable. Of the remaining 225,000 options, which are non-plan options, an additional 75,000 options will become exercisable on December 31 of each of the 2002, 2003 and 2004. *** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). By: /s/ Frank Mandelbaum Jan. 2, 2003 -------------------------------- --------------- ***Signature of Reporting Person Date Frank Mandelbaum
+The disposal of these rights was due to sales of shares by prudential Securities Incorporated as Pledgee of Mr. Mandelbaum's shares. ++ The deduction of 200 Rights due to sales on September 17 and September 18 were inadvertently omitted. 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.