SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
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SCHEDULE 13G
(Rule 13d-102)
INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT
TO RULES 13d-1(b), (c) AND (d) AND AMENDMENTS THERETO FILED
PURSUANT TO 13d-2(b)
(AMENDMENT NO. 4)1
INTERCEPT, INC.
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(Name of Issuer)
Common Stock, no par value per share
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(Title of Class of Securities)
45845L107
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(CUSIP Number)
December 31, 2002
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(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule
is filed:
|_| Rule 13d-1(b)
|_| Rule 13d-1(c)
|X| Rule 13d-1(d)
1 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 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).
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CUSIP No. 45845L107 13G/A Page 2 of 5 Pages
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1. NAMES OF REPORTING PERSONS John W. Collins
I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY)
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2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) |_|
(b) |_|
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3. SEC USE ONLY
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4. CITIZENSHIP OR PLACE OF ORGANIZATION U.S. Citizen
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5. SOLE VOTING POWER 1,728,608
NUMBER OF
SHARES ---------------------------------------------------------------
BENEFICIALLY
OWNED BY 6. SHARED VOTING POWER 300,000 (a)
EACH
REPORTING ---------------------------------------------------------------
PERSON WITH
7. SOLE DISPOSITIVE POWER 1,728,608
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8. SHARED DISPOSITIVE POWER 300,000 (a)
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9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
2,028,608
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10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES
CERTAIN SHARES* |_|
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11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
9.78%
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12. TYPE OF REPORTING PERSON*
IN
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2
Item 1(a). Name of Issuer:
InterCept, Inc.
Item 1(b). Address of Issuer's Principal Executive Offices:
3150 Holcomb Bridge Road, Suite 200
Norcross, GA 30071
Item 2(a). Name of Person Filing:
John W. Collins
Item 2(b). Address of Principal Business Office or, if None, Residence:
3150 Holcomb Bridge Road, Suite 200
Norcross, GA 30071
Item 2(c). Citizenship:
United States of America
Item 2(d). Title of Class of Securities:
Common Stock
Item 2(e). CUSIP Number:
45845L107
Item 3. If This Statement is Filed Pursuant to Rule 13d-1(b), or
13d-2(b) or (c), Check Whether the Person Filing is a:
Not applicable.
Item 4. Ownership.
(a) Amount Beneficially Owned:
2,028,608
(b) Percent of Class:
9.78%
3
(c) Number of Shares as to which such person has:
(i) sole power to vote or to direct the vote
1,728,608
(ii) shared power to vote or to direct the vote
300,000 (a)
(iii) sole power to dispose or to direct the
disposition of
1,728,608
(iv) shared power to dispose or to direct the
disposition of
300,000 (a)
Item 5. Ownership of Five Percent or Less of a Class.
Not applicable.
Item 6. Ownership of More Than Five Percent on Behalf of Another
Person.
Not applicable.
Item 7. Identification and Classification of the Subsidiary Which
Acquired the Security Being Reported on By the Parent
Holding Company.
Not applicable.
Item 8. Identification and Classification of Members of the Group.
Not applicable.
Item 9. Notice of Dissolution of Group.
Not applicable.
Item 10. Certifications.
Not applicable.
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Note (a): On April 19, 2001, the reporting person entered into a variable
forward contract with a scheduled valuation date of April 9, 2004, with respect
to shares of common stock. The initial number of shares pledged under the
contract is 300,000 (the reporting person will be required to deliver a small
amount of additional shares in the unlikely event that the issuer pays cash
dividends in respect of the pledged shares). The minimum price the reporting
person will receive under the contract is $26.1292 per share and the maximum
price is $31.3550 per share. The reporting person has the right to cash settle
or surrender the pledged shares at the termination of the contract. The
reporting person retains voting authority and power with respect to the pledged
shares during the term of the contract. The reporting person intends this
contract to comply with Rule 10b5-1.
5
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.
February 12, 2003
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(Date)
/s/ John W. Collins
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John W. Collins,
Chairman and C.E.O.
InterCept, Inc.
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