-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, D6Q6PU00jagkkWhiUuUjpwPlVXKI4b9Lngo1wAZREr8v5PqEAWvKHVC5wR8p7Yt/ cj9lYJI9zTrs5NjxMh1VPQ== 0001209191-04-024722.txt : 20040510 0001209191-04-024722.hdr.sgml : 20040510 20040510165023 ACCESSION NUMBER: 0001209191-04-024722 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040506 FILED AS OF DATE: 20040510 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: INTEGRAL VISION INC CENTRAL INDEX KEY: 0000719152 STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL INSTRUMENTS FOR MEASUREMENT, DISPLAY, AND CONTROL [3823] IRS NUMBER: 382191935 STATE OF INCORPORATION: MI FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 38700 GRAND RIVER AVE CITY: FARMINGTON HILLS STATE: MI ZIP: 48335 BUSINESS PHONE: 8104773900 MAIL ADDRESS: STREET 1: 38700 GRAND RIVER AVENUE CITY: FARMINGTON HILLS STATE: MI ZIP: 48335 FORMER COMPANY: FORMER CONFORMED NAME: MEDAR INC DATE OF NAME CHANGE: 19920703 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KIELY JOHN R III CENTRAL INDEX KEY: 0001222337 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-12728 FILM NUMBER: 04793794 BUSINESS ADDRESS: STREET 1: 17817 DAVIS ROAD CITY: DUNDEE STATE: MI ZIP: 48131 BUSINESS PHONE: 7342791800 MAIL ADDRESS: STREET 1: 17817 DAVIS ROAD CITY: DUNDEE STATE: MI ZIP: 48131 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2004-05-06 0 0000719152 INTEGRAL VISION INC INVI 0001222337 KIELY JOHN R III 17817 DAVIS ROAD DUNDEE MI 48131 0 0 1 0 common stock 617100.0000 D common stock 300000.0000 I Trustee common stock 1500.0000 I Custodian for my two children common stock 10200.0000 I Co-Trustee Michael Kiely Trust warrants 0.8000 2002-12-11 2006-12-11 common 22740.0000 22740.0000 D warrants 0.2500 2001-07-18 2007-02-27 common 150000.0000 150000.0000 D warrants 0.2500 2002-02-04 2007-02-27 common 75000.0000 75000.0000 D warrants 0.2500 2003-02-27 2007-02-27 common 600000.0000 600000.0000 D convertible note 0.7500 2004-05-06 4 J 0 46910.0000 46910.0000 A 2004-05-06 2006-07-03 common 62546.0000 62546.0000 D warrants 0.2500 2003-07-30 2007-07-30 common 120000.0000 120000.0000 D warrants 0.3500 2003-09-29 2007-09-29 common 225000.0000 225000.0000 D warrants 0.8000 2002-12-11 2006-12-11 common 42603.0000 42603.0000 I Trustee warrants 0.2500 2002-05-31 2007-02-27 common 50000.0000 50000.0000 I Trustee warrants 0.2500 2003-07-07 2007-07-07 common 7479.0000 7479.0000 I Trustee warrants 0.2500 2003-07-15 2007-07-15 common 300000.0000 300000.0000 I Trustee convertible note 0.7500 2004-05-06 4 J 0 19411.0000 19411.0000 A 2004-05-06 2007-02-27 common 25881.0000 25881.0000 D convertible note 0.7500 2004-05-06 4 J 0 16406.0000 16406.0000 A 2004-05-06 2006-07-03 common 21874.0000 21874.0000 I Trustee convertible note 0.7500 2004-05-06 4 J 0 38823.0000 38823.0000 A 2004-05-06 2007-02-27 common 51764.0000 51764.0000 I Trustee Trustee means Trustee of the John R. & Margaret Lee Kiely 1979 Trust acquired pursuant to the Fourth Amended Note and Warrant Purchase Agreement which has been filed by issuer as an Exhibit to their 10K on 03/26/2004 dollar amount of accrued interest due pursuant to Fourth Amended Note and Warrant Purchase Agreement Section 1.c. dollar amount of secured non-convertible notes together with accrued interest due thereon exchanged for this convertible note pursuant to the Fourth Amended Note and Warrant Purchase Agreement Section 1.e. JOHN R. KIELY, III 2004-05-10 -----END PRIVACY-ENHANCED MESSAGE-----