Statement of Changes in Beneficial Ownership (4)
December 03 2015 - 1:03PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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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1. Name and Address of Reporting Person
*
Engmann Michael W.
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2. Issuer Name
and
Ticker or Trading Symbol
COMMUNICATION INTELLIGENCE CORP
[
CICI
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
220 BUSH STREET, SUITE 950
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3. Date of Earliest Transaction
(MM/DD/YYYY)
5/17/2013
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(Street)
SAN FRANCISCO, CA 94104
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Series D-1 Preferred
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$0.0225
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5/17/2013
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P
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40000
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5/17/2013
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(1)
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Common Stock
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1777778
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(2)
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40000
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D
(3)
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Series D-2 Preferred
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$0.05
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5/17/2013
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P
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160000
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5/17/2013
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(1)
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Common Stock
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3200000
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(2)
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160000
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D
(3)
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Warrants
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$0.03
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11/6/2013
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J
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6250000
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11/6/2013
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11/5/2016
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Common Stock
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6250000
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(4)
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6250000
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D
(3)
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Warrants
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$0.03
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12/13/2013
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J
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5000000
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12/13/2013
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12/12/2016
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Common Stock
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5000000
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(4)
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5000000
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D
(3)
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Warrants
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$0.0275
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12/31/2013
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J
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4881407
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12/31/2013
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12/30/2016
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Common Stock
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4881407
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(5)
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4881407
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D
(3)
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Series D-1 Preferred
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$0.0225
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12/31/2013
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J
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357415
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12/31/2013
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(1)
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Common Stock
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15885111
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(6)
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397415
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D
(3)
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Series D-2 Preferred
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$0.05
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12/31/2013
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J
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178707
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12/31/2013
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(1)
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Common Stock
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3574140
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(6)
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338707
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D
(3)
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Series D-1 Preferred
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$0.0225
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12/31/2013
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J
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133333
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12/31/2013
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(1)
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Common Stock
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5925911
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(7)
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533308
(8)
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D
(3)
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Series D-2 Preferred
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$0.05
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12/31/2013
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J
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66667
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12/31/2013
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(1)
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Common Stock
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1333340
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(7)
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415616
(8)
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D
(3)
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Series D-1 Preferred
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$0.0225
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12/31/2013
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J
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40000
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5/17/2013
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(1)
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Common Stock
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1777778
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(9)
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493308
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D
(3)
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Series D-2 Preferred
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$0.05
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12/31/2013
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J
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160000
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5/17/2013
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(1)
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Common Stock
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3200000
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(9)
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255616
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D
(3)
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Warrants
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$0.0275
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12/31/2013
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J
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1818181
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12/31/2013
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12/31/2016
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Common Stock
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1818181
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(10)
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6699588
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D
(3)
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Warrants
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$0.0275
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5/15/2014
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J
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4881407
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5/15/2014
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5/14/2017
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Common Stock
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4881407
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(5)
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4881407
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D
(3)
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Warrants
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$0.0275
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5/15/2014
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J
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1818181
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5/15/2014
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12/31/2016
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Common Stock
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1818181
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(11)
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1818181
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D
(3)
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Series D-1 Preferred
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$0.0225
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8/5/2014
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P
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400000
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8/5/2014
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(1)
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Common Stock
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17777778
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$1.00
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893308
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D
(3)
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Warrants
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$0.0275
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8/14/2014
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J
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1818181
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8/14/2014
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12/31/2016
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Common Stock
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1818181
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(11)
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1818181
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D
(3)
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Warrants
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$0.0275
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8/14/2014
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J
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4881407
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8/14/2014
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8/13/2017
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Common Stock
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4881407
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(5)
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4881407
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D
(3)
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Warrants
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$0.0275
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11/14/2014
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J
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1818181
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11/14/2014
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12/31/2016
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Common Stock
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1818181
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(11)
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1818181
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D
(3)
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Warrants
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$0.0275
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11/14/2014
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J
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4881407
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11/14/2014
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11/13/2017
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Common Stock
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4881407
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(5)
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4881407
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D
(3)
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Series D-1 Preferred
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$0.0225
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3/24/2015
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P
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1000000
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3/24/2015
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(1)
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Common Stock
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44444444
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(12)
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1961504
(13)
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D
(3)
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Warrants
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$0.0225
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3/24/2015
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P
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1000000
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3/24/2015
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3/23/2018
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Common Stock
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22222222
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(12)
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1000000
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D
(3)
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Series D-1 Preferred
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$0.0225
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7/23/2015
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P
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200000
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7/23/2015
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(1)
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Common Stock
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8888889
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(14)
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2161504
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D
(3)
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Warrants
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$0.0125
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7/23/2015
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P
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200000
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7/23/2015
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7/22/2018
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Common Stock
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8000000
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(14)
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200000
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D
(3)
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Series D-1 Preferred
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$0.0225
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9/30/2015
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J
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130284
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9/30/2015
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(1)
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Common Stock
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5790400
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(15)
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2291788
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D
(3)
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Series D-2 Preferred
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$0.05
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9/30/2015
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J
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21657
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9/30/2015
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(1)
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Common Stock
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433140
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(15)
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304116
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D
(3)
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Warrants
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$0.0225
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11/10/2015
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H
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1000000
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3/24/2015
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3/23/2018
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Common Stock
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22222222
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(16)
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0
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D
(3)
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Warrants
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$0.0125
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11/10/2015
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P
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1000000
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11/10/2015
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3/23/2018
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Common Stock
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16000000
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(16)
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1000000
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D
(3)
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Warrants
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$0.0125
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11/10/2015
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J
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17777778
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11/10/2015
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11/9/2018
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Common Stock
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17777778
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(16)
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17777778
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D
(3)
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Options
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$0.008
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11/16/2015
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A
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1000000
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(17)
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11/15/2023
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Common Stock
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1000000
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(17)
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1000000
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D
(3)
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Explanation of Responses:
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(
1)
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The conversion rights of these securities do not expire.
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(
2)
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These securities are components of the Issuer's Series D Convertible Preferred Stock units. Each unit had a price of $5 and consisted of one share of Series D-1 Convertible Preferred Stock ("Series D-1") and four shares of Series D-2 Convertible Preferred Stock ("Series D-2").
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(
3)
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These securities are owned solely by Michael W. Engmann, who is a member of a "group" for purposes of section 13(d) of the Securities Exchange Act of 1934, as amended, with MDNH Partners, LP, a California limited partnership.
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(
4)
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These securities were issued under the terms of certain indebtedness of the Issuer to Mr. Engmann that entitled him to receive warrants based on whether the Issuer achieved certain revenue targets.
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(
5)
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These securities were issued under the terms of certain indebtedness of the Issuer to Mr. Engmann and interest thereon, which terms entitled him to receive warrants based on whether the Issuer achieved certain revenue targets.
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(
6)
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These securities were issued in exchange for the conversion of $525,000 in indebtedness of the Issuer to Mr. Engmann and $11,122 in interest thereon.
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(
7)
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These securities are components of the Issuer's Units issued on December 31, 2013. Each Unit had a price of $3 and consisted of two shares of Series D-1 and one share of Series D-2. Mr. Engmann received them and the warrants described in Note 10 in exchange for the securities issued on May 17, 2013 described above and the conversion of indebtedness of the Issuer to Mr. Engmann.
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(
8)
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On December 31, 2013, Mr. Engmann received a stock dividend of 2,560 shares of Series D-1 and 10,242 shares of Series D-2.
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(
9)
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These securities were exchanged as described in Note 7 and the Issuer's Form 8-K filed January 7, 2014.
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(
10)
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These warrants were issued in connection with the transactions described in Notes 7 and 9. As described in the Form 8-K referred to in Note 9, those transactions entitled Mr. Engmann to receive additional warrants based on whether the Issuer achieved certain revenue targets in 2014.
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(
11)
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These are additional warrants issued as described in Note 10.
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(
12)
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These securities are components of the Issuer's units issued on this date at a purchase price of $1.00 per unit. Each unit consisted of one share of Series D-1 and one warrant to purchase 22.22 shares of the Issuer's common stock.
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(
13)
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On December 31, 2014, Mr. Engmann received a stock dividend of 68,196 shares of Series D-1 and 26,843 shares of Series D-2.
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(
14)
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These securities are components of the Issuer's units issued on this date at a purchase price of $1.00 per unit. Each unit consisted of one share of Series D-1 and one warrant to purchase 40 shares of the Issuer's common stock.
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(
15)
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Stock dividend.
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(
16)
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On this date, the exercise price of the Warrants issued March 24, 2015 was reduced and Mr. Engmann was issued additional warrants.
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(
17)
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These options were granted under the Issuer's 2011 Stock Compensation Plan in connection with Mr. Engmann's service as a director of the Issuer, will vest quarterly over three years and have a seven-year term.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Engmann Michael W.
220 BUSH STREET
SUITE 950
SAN FRANCISCO, CA 94104
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X
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X
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Signatures
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Michael W. Engmann
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12/2/2015
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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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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Note:
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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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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.
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