0001493152-21-004616.txt : 20210223 0001493152-21-004616.hdr.sgml : 20210223 20210223170729 ACCESSION NUMBER: 0001493152-21-004616 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210222 FILED AS OF DATE: 20210223 DATE AS OF CHANGE: 20210223 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: EMBRY RUSSELL T CENTRAL INDEX KEY: 0001197709 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15465 FILM NUMBER: 21666664 MAIL ADDRESS: STREET 1: INTELLI CHECK INC STREET 2: 246 CROSSWAYS PARK CITY: WOODBURY STATE: NY ZIP: 11797 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Intellicheck, Inc. CENTRAL INDEX KEY: 0001040896 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 113234779 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 100 JERICHO QUADRANGLE, STREET 2: SUITE 202 CITY: JERICHO STATE: NY ZIP: 11753 BUSINESS PHONE: 516-992-1900 MAIL ADDRESS: STREET 1: 100 JERICHO QUADRANGLE, STREET 2: SUITE 202 CITY: JERICHO STATE: NY ZIP: 11753 FORMER COMPANY: FORMER CONFORMED NAME: Intellicheck Mobilisa, Inc. DATE OF NAME CHANGE: 20100527 FORMER COMPANY: FORMER CONFORMED NAME: Intelli Check Mobilisa, Inc DATE OF NAME CHANGE: 20080319 FORMER COMPANY: FORMER CONFORMED NAME: INTELLI CHECK INC DATE OF NAME CHANGE: 19990917 4 1 ownership.xml X0306 4 2021-02-22 0 0001040896 Intellicheck, Inc. IDN 0001197709 EMBRY RUSSELL T 535 BROAD HOLLOW ROAD, SUITE B51 MELVILLE NY 11747 0 1 0 0 Chief Technology Officer Common Stock, $.001 par value 2021-02-22 4 F 0 22279 13.32 D 73562 D Common Stock, $.001 par value 2021-02-22 4 M 0 14001 1.01 A 87563 D Option (Right to Buy) 1.01 2021-02-22 4 M 0 22279 0 D 2016-02-24 2021-02-24 Common Stock 22279 0 D Of the 22,279 options granted, 8,278 were surrendered to Intellicheck as settlement for the cashless exercise and tax withholding resulting in the acquisition of 14,001 shares. /s/ Russell T. Embry 2021-02-23