SEC 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
|Estimated average burden|
|hours per response:
||Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
1. Name and Address of Reporting Person*
|25501 WEST VALLEY PARKWAY|
2. Issuer Name and Ticker or Trading Symbol
[ EGOV ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
||Officer (give title below)
||Other (specify below)
|Sr VP, Business Development|
3. Date of Earliest Transaction
4. If Amendment, Date of Original Filed
6. Individual or Joint/Group Filing (Check Applicable Line)
||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.
||2. Transaction Date
||2A. Deemed Execution Date, if any
||3. Transaction Code (Instr.
||4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
||6. Ownership Form: Direct (D) or Indirect (I) (Instr.
||7. Nature of Indirect Beneficial Ownership (Instr.
||(A) or (D)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned|
(e.g., puts, calls, warrants, options, convertible securities)
|1. Title of Derivative Security (Instr.
||2. Conversion or Exercise Price of Derivative Security
||3. Transaction Date
||3A. Deemed Execution Date, if any
||4. Transaction Code (Instr.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
||6. Date Exercisable and Expiration Date
||7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
||8. Price of Derivative Security (Instr.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
||10. Ownership Form: Direct (D) or Indirect (I) (Instr.
||11. Nature of Indirect Beneficial Ownership (Instr.
||Amount or Number of Shares
|Explanation of Responses:|
||/s/Josh Johnson, Attorney-in-Fact for Douglas Rogers
||** Signature of Reporting Person
|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,
|** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).|
|Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
Instruction 6 for procedure.|
|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 Number.|
POWER OF ATTORNEY
Know all by these presents, that the undersigned, Douglas Rogers,
in all capacities, including but not limited to his individual capacity and
as a trustee of any trust, hereby constitutes and appoints each of William A.
Van Asselt, Stephen M. Kovzan and Josh Johnson, signing singly, the
undersigned's true and lawful attorney-in-fact to:
(1) prepare and execute for and on behalf of the undersigned, in
the undersigned's name, place and stead, in any and all such capacities:
(a) Forms 3, 4 and 5 (including amendments thereto and joint filing
agreements in connection therewith) pursuant to Section 16(a) of the
Securities Exchange Act of 1934, as amended, and the rules thereunder,
(b) Form 144 pursuant to Rule 144 under the Securities Act of 1933, as
amended, (c) Schedules 13D and 13G (including amendments thereto and
joint filing agreements in connection therewith) pursuant to Sections 13(d)
and 13(g) of the Securities Exchange Act of 1934, as amended, and the
rules thereunder and (d) any other forms or reports (or related documents)
that may be required to be filed with the Securities and Exchange
Commission, any other governmental agency or any stock exchange or
similar authority in connection with the ownership, acquisition
disposition of securities issued by NIC Inc. (the "Company");
(2) prepare and execute for and on behalf of the undersigned, in
the undersigned's name, place and stead, in any and all such capacities, a
Form ID, including amendments thereto, and any other documents
necessary or appropriate to obtain codes and passwords enabling the
undersigned to make electronic filings with the Securities and Exchange
Commission of the foregoing forms, reports and documents;
(3) do and perform any and all acts for and on behalf of the
undersigned that may be necessary or desirable to complete and execute any
such Form ID, Forms 3, 4 and 5, Form 144, Schedules 13D and 13G or
other forms, reports or documents, complete and execute any amendment or
amendments thereto, and timely file such form, report or document with the
Securities and Exchange Commission, other required governmental agency
and any stock exchange or similar authority; and
(4) take any other action of any type whatsoever in connection
with the foregoing that, in the opinion of each such attorney-in-fact, may
be of benefit to, in the best interest of, or legally required by, the
undersigned, it being understood that the documents executed by each such
attorney-in-fact on behalf of the undersigned pursuant to this Power of
Attorney shall be in such form and shall contain such terms and conditions
as each such attorney-in-fact may approve in such attorney-in-fact's
The undersigned hereby grants to each such attorney-in-fact full
power and authority to do and perform any and every act and thing
whatsoever requisite, necessary or proper to be done in the exercise of any
of the rights and powers herein granted, as fully to all intents and purposes
as the undersigned might or could do if personally present, with full power
of substitution, re-substitution or revocation, hereby ratifying and
confirming all that each such attorney-in-fact, or such attorney-in-fact's
substitute or substitutes shall lawfully do or cause to be done by virtue of
this Power of Attorney and the rights and powers herein granted. The
undersigned acknowledges that each of the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, is not assuming,
nor is the Company assuming, any of the undersigned's responsibilities to
comply with Rule 144 under the Securities Act of 1933, as amended,
Sections 13 or 16 of the Securities Exchange Act of 1934, as amended, any
other provisions of such Acts, or any of the rules thereunder.
The undersigned agrees that each such attorney-in-fact may rely
entirely on information furnished orally or in writing by the undersigned
to the attorney-in-fact. The undersigned also agrees to indemnify and hold
harmless the Company and each such attorney-in-fact against any losses,
claims, damages or liabilities (or actions in these respects) that arise out
of or are based upon any information provided by the undersigned to such
attorney-in-fact for purposes of executing, acknowledging, delivering or
filing any reports, forms or documents pursuant to this Power of Attorney
and agrees to reimburse the Company and each attorney-in-fact on demand
for any legal or other expenses reasonably incurred in connection with
investigating or defending against any such loss, claim, damage, liability
or action. This paragraph shall survive the termination of the Power of
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file a Form ID, Forms 3, 4 and 5, Form
144, Schedules 13D and 13G or other reports, forms or documents with
respect to the undersigned's holding of and transaction in securities issued
by the Company, unless earlier revoked by the undersigned in a signed
writing delivered to each of the foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power
of Attorney to be executed as of this 30 day of July, 2018.