-----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, FQHvpjDZocBqzXJ8gt9AN9tXU2I1YW+jShgOTYXLYgqmLRt74qLyizpxeZuycteJ LgEkvB6F7tp8osg4wrFsiQ== 0001140361-03-000259.txt : 20030203 0001140361-03-000259.hdr.sgml : 20030203 20030203144244 ACCESSION NUMBER: 0001140361-03-000259 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030124 FILED AS OF DATE: 20030203 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: DEPELISI JAMES CENTRAL INDEX KEY: 0001216967 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 3 MAIL ADDRESS: STREET 1: 10640 NW 32 STREET CITY: SUNRISE STATE: FL ZIP: 33351 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: 21ST CENTURY HOLDING CO CENTRAL INDEX KEY: 0001069996 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 650248866 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25001 FILM NUMBER: 03536313 BUSINESS ADDRESS: STREET 1: 4161 N W 5TH STREET CITY: PLANTATION STATE: FL ZIP: 33317 BUSINESS PHONE: 9545819993 MAIL ADDRESS: STREET 1: 4161 N W 5TH STREET CITY: PLANTATION STATE: FL ZIP: 33317 3 1 doc1.htm Form 3
Form 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549


INITIAL STATEMENT OF 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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1. Name and Address of Reporting Person*     

DePelisi, James
(Last)       (First)       (Middle)

4161 NW 5 Street
(Street)

Plantation, Florida 33317

(City)       (State)       (Zip)
2. Date of Event
Requiring Statement
(Month/Day/Year)

01/24/2003
4. Issuer Name and Ticker or Trading Symbol

21st Century Holding Company   (TCHC)
3. I.R.S. Identification
Number of Reporting
Person, if an entity
(voluntary)


5. Relationship of Reporting Person(s) to Issuer
                  (Check all applicable)
_X_ Director                          ___ 10% Owner
___ Officer (give title below)   ___ Other (specify below)


6. If Amendment, Date of
Original (Month/Day/Year)
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 Beneficially Owned
1. Title of Security
(Instr. 4)
2. Amount of Securities
Beneficially Owned
(Instr. 4)
3. Ownership
Form: Direct
(D) or Indirect
(I)  (Instr. 5)
4. Nature of Indirect Beneficial Ownership
(Instr. 5)
       
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 Instructions 5(b)(v).
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 control number.

(Over)
SEC 1474 (7-02)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 4)
2. Date Exercisable and
Expiration Date
(Month/Day/Year)

3. Title and Amount of Securities Underlying
Derivative Security
(Instr. 4)
4. Conversion or
Exercise
Price of
Derivative
Security
5. Ownership
Form of
Derivative
Security:
Direct
(D) or
Indirect
(I)
(Instr. 5)
6. Nature of Indirect
Beneficial Ownership
(Instr. 5)
Date Exercisable Expiration Date Title Amount
or
Number
of
Shares
Options 01/24/2004 (1) 01/23/2009 Common Stock 10,000 13.75 D  
Explanation of Responses:

1. The options vest 20% per year beginning January 24, 2004.


** Intentional misstatements || omissions of facts constitute Federal Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
/s/ James DePelisi
**Signature of Reporting Person
James DePelisi
02/03/2003 
Date
Note: File three copies of this Form, one of which must be manually signed.
If space is insufficient,
See Instruction 6 for procedure.
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