Amended Statement of Ownership (sc 13g/a)
February 14 2020 - 4:33PM
Edgar (US Regulatory)
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. 3)*
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
*The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information
which would alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of
that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
1
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NAMES OF REPORTING PERSONS
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Rawleigh Hazen Ralls, IV
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP
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(a) ☐
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(b) ☒
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF ORGANIZATION
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United States of America
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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5
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SOLE VOTING POWER
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820,751 (1)
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6
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SHARED VOTING POWER
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343,807
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7
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SOLE DISPOSITIVE POWER
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820,751 (1)
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8
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SHARED DISPOSITIVE POWER
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343,807
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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1,164,558 (1)
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10
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CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
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☐
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
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7.3% (2)
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12
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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IN
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(1) Includes 14,000 shares which Mr. Ralls has the right to acquire within sixty days of December 31, 2019 upon conversion of certain call options of the Issuer.
(2) This percentage is calculated based upon 15,885,150 shares of the Issuer’s common stock outstanding as of November 13, 2019 as reported in the Issuer’s Quarterly Report
on Form 10-Q for the period ended September 30, 2019 (Commission File No. 000-50296) filed with the Securities and Exchange Commission on November 13, 2019.
CUSIP No. 45817G201
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Page 3 of 5 Pages
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Intellicheck, Inc.
100 Jericho Quadrangle, Suite 202
Jericho, New York 11753
Rawleigh Hazen Ralls, IV
c/o Lacuna, LLC
1100 Spruce Street, Suite 202
Boulder, Colorado 80302
United States of America
Common Stock, $0.001 par value
45817G201
Item 3
Not applicable.
If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the
class of securities, check the following. ☐
CUSIP No. 45817G201
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Page 4 of 5 Pages
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Not applicable.
Not applicable.
Not applicable.
Not applicable.
By signing below, I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the
effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect, other than activities solely in connection
with a nomination under § 240.14a-11.
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
EXECUTED this 14th day of February, 2020.
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