SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this 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*
Goren Andrea

(Last) (First) (Middle)
275 SHORELINE DRIVE
SUITE 500

(Street)
REDWOOD SHORES CA 94065

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
COMMUNICATION INTELLIGENCE CORP [ CICI.OB ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Acting Chief Financial Officer
3. Date of Earliest Transaction (Month/Day/Year)
03/31/2011
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. 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
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series C Participating Convertible Preferred Stock $0.0225 03/31/2011 P(3)(4) 6,250 (1) (2) Common Stock 277,778(3)(4) $1 5,000 I(5) See Footnote 5(5)
Warrant (Right to buy) $0.0225 03/31/2011 J(3)(4) 277,778 03/31/2011 03/31/2014 Common Stock 277,778(3)(4) $0.0225 277,778 I(5) See Footnote(5)
Explanation of Responses:
1. Each share of Series C Participating Convertible Preferred Stock of Communication Intelligence Corp. (the "Issuer"), par value $0.01 per share (the "Series C Preferred Stock"), is convertible at any time, at the holder's election, into shares of Common Stock at a conversion price of $0.0225 per share, subject to adjustment for stock dividends, splits, combinations and similar events.
2. Each share of Series C Preferred Stock shall automatically convert into shares of Common Stock at the then applicable conversion rate upon the written consent of the holders of a majority of the then outstanding shares of Series C Preferred Stock.
3. On March 31, 2011, the Issuer entered into subscription agreements with 15 investors (collectively, the "Investors") relating to the sale and issuance to the Investors by the Issuer of (1) an aggregate of 800,000 shares of Series C Preferred Stock and (2) warrants to purchase a number of shares of the Issuer's Common Stock equal to the total number of shares of Series C Preferred Stock purchased by each such Investor divided by 0.225 at an exercise price of $0.0225 per share (collectively, the "Follow On Financing").
4. The Series C Preferred Stock issued in connection with the Financing is convertible at any time, at the holder's election, into shares of Common Stock at a conversion price of $0.0225 per share, subject to adjustment for stock dividends, splits, combinations and similar events. The Follow On Financing was consummated on March 31, 2011 and Andax LLC purchased 6,250 shares of Series C Preferred Stock and received warrants to purchase 277,778 shares of Common Stock in connection with the consummation.
5. The securities acquired by Andax LLC and may be deemed to be indirectly beneficially owned by Mr. Goren, the managing member of Andax LLC. This filing shall not be deemed as an admission by Mr. Goren that Mr. Goren is, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of any equity securities covered by this statement. Mr. Goren disclaims beneficial ownership of the reported securities, except to the extent of his pecuniary interest, if any, therein.
Remarks:
Andrea Goren 04/04/2011
** Signature of Reporting Person Date
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 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).
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