-----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, VVH5JoNBznNOSPviw4jp18m2gKpVgNIMdsmoIDuGUeh8zdmjDtppbg+0uMoZm9d/ B9LBbMlTp7124agOeNRNTQ== 0001049778-99-000001.txt : 19990107 0001049778-99-000001.hdr.sgml : 19990107 ACCESSION NUMBER: 0001049778-99-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981231 FILED AS OF DATE: 19990106 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: ADVANCED MACHINE VISION CORP CENTRAL INDEX KEY: 0000795445 STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL INSTRUMENTS FOR MEASUREMENT, DISPLAY, AND CONTROL [3823] IRS NUMBER: 330256103 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 000-20097 FILM NUMBER: 99501168 BUSINESS ADDRESS: STREET 1: 3709 CITATION WAY STREET 2: STE 102 CITY: MEDFORD STATE: OR ZIP: 97504 BUSINESS PHONE: 5417767700 MAIL ADDRESS: STREET 1: 3709 CITATION WAY STREET 2: STE 102 CITY: MEDFORD STATE: OR ZIP: 97504 FORMER COMPANY: FORMER CONFORMED NAME: ARC CAPITAL DATE OF NAME CHANGE: 19951222 FORMER COMPANY: FORMER CONFORMED NAME: APPLIED LASER SYSTEMS /CA DATE OF NAME CHANGE: 19930825 COMPANY DATA: COMPANY CONFORMED NAME: VAN VOORHIS RODGER A CENTRAL INDEX KEY: 0001049778 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR IRS NUMBER: 560412276 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 4217 W FIFTH AVE CITY: EUGENE STATE: OR ZIP: 97402 BUSINESS PHONE: 5417767700 MAIL ADDRESS: STREET 1: 2067 COMMERCE CITY: MEDFORD STATE: OR ZIP: 97504 4 1 FORM 4 FORM 4 U. S. 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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940. |_| Check this box if no longer OMB APPROVAL subject to Section 16. Form 4 OMB Number 3235-0287 or Form 5 obligations may Expires: February 1, 1994 continue. See Instruction 1(b). Estimated average burden hours per response.....0.5
- ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person to Van Voorhis A. Rodger Advanced Machine Vision Corporation (AMVC) Issuer (Check all applicable) ------------------------------------ ---------------------------------------- (Last) (Middle) (First) 3. IRS or Social Security Number of |X| Director |_| 10% Owner 4217 West Fifth Avenue Reporting Person (Voluntary) |_| Officer |_| Other ------------------------------------ (give title (specify (Street) 4. Statement for Month/Year below) below) Eugene OR 97402 December 1998 ------------------------------------ ---------------------------------------- (City) (State) (Zip) 5. If Amendment, Date of Original (Month/Year) - ------------------------------------------------------------------------------------------------------------------------------------ Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security | 2. Transaction Date | 3. Transaction | 4. Securities Acquired |5. Amount of |6. Ownership |7. Nature (Instr. 3) | (Month/Day/Year) | Code | (A) or Disposed of(D)| Securities | Form: Direct | Indirect | | (Instr. 8) | (Instr. 3, 4 and 5) | Beneficially| (D) or (I) | Beneficial | | | | Owned at | (Instr. 4) | Ownership | | | | End of Month| | (Instr. 4) | | | | (Instr. 3&4)| | | |----------------|-------------------------| | | | | Code | V | Amount | (A) or | Price | | | | | | | | or | | | | | | | | | (D) | | | | - ---------------------|---------------------|--------|-------|--------|--------|-------|--------------|----------------|------------- Class A Common Stock | 12/22/98 | P | | 20,000 | A | $1.19 | 74,000 (1) | D & I | - ---------------------|---------------------|--------|-------|--------|--------|-------|--------------|----------------|------------- | | | | | | | | | - ---------------------|---------------------|--------|-------|--------|--------|-------|--------------|----------------|------------- | | | | | | | | | - ---------------------|---------------------|--------|-------|--------|--------|-------|--------------|----------------|------------- | | | | | | | | | - ---------------------|---------------------|--------|-------|--------|--------|-------|--------------|----------------|------------- | | | | | | | | | - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or type responses) (OVER) SEC 1474 (8/92)
FORM 4 (continued)
- ------------------------------------------------------------------------------------------------------------------------------------ Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of |2. Conver- |3. Trans- |4. Trans- |5. Number |6. Date |7. Title |8. Price |9. Number |10. Owner- |11. Nature Derivative| sion or | action | action | of | Exercis- | and | of | of | ship | of Security | Exercise | Date | Code | Deriva- | able and | Amount | Deriva-| Deriva-| Form | Indirect | Price of | (Month/ | | tive | Expira- | of | tive | tive | of | Beneficial | Deriva- | Day/ | | Securi- | tion | Under- | Securi-| Securi-| Deriva-| Ownership | tive | Year) | | ties | Date | lying | ty | ties | tive | | Security | | | Acquired| (Month/ | Securi-| | Benefi-| Secur- | | | | | (A) or | Day/ | ties | | cially | ity | | | | | Disposed| Year) | | | Owned | Direct | | | | | (D) of | | | | at End | (D) or | | | | | | | | | of | In- | | | | | | | | | Month | direct | | | | | | | | | | (I) | | | | | | | | | | | | | | (Instr. | (Instr. 3,| | (Instr. | (Instr. | (Instr. | (Instr. | (Instr. (Instr. 3) | | | 8) | 4 and 5) | | 3 & 4) | 5) | 4) | 4) | 4) - -------------|------------|-----------|-----------|-----------|------------|----------|----------|----------|-----------|----------- | | |Code | V | (A) | (D) |Date|Expira-|Title|Amount| | | | | | | | | | |Exer| tion | |or | | | | | | | | | | |cis-| Date | |Number| | | | | | | | | | |able| | |Shares| | | | - -------------|------------|-----------|-----|-----|-----|-----|----|-------|-----|------|--------|----------|-----------|----------- Convertible | $2.25 | 1/24/97 | | |$2.25| |1/24| 7/23/ |Class| 333, | $2.25 | $2.25 | I | (2) Note (2) | | | | | Mil.| |1997| 1999 |A | 333 | Million| Million | | | | | | | | | | |Common | | | | | | | | | | | | |Stock| | | | | - -------------|------------|-----------|-----|-----|-----|-----|----|-------|-----|------|--------|----------|-----------|----------- Warrants (2) | $2.25 | 1/24/97 | | | 250,| |3/31| 7/23/ |Class| 250, | (2) | 250,000 | I | (2) | | | | | 000 | |1997| 2001 |A | 000 | | | | | | | | | | | | |Common | | | | | | | | | | | | |Stock| | | | | - -------------|------------|-----------|-----|-----|-----|-----|----|-------|-----|------|--------|----------|-----------|----------- | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - -------------|------------|-----------|-----|-----|-----|-----|----|-------|-----|------|--------|----------|-----------|----------- Explanation of Responses: (1) 25,000 shares are owned by Whamdyne LLC, which is 25% owned by Reporting Person. 49,000 shares are owned by Reporting Person. (2) Derivative securities are owned by Veneer Technology, Inc., which is 25% owned by Reporting Person. The number of shares underlying the Convertible Note represents that number of securities now obtainable through conversion due to achievement of earnings goals. Additional shares will become obtainable by converstion in the future on achievement of sales and earnings goals or passage of time. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U. S. C. 1001 and 15 U.S.C. 78ff (a). /s/ Rodger A. Van Vorrhis 12/22/98 ________________________________ _____________ ** Signature of Reporting Person Date Reminder: Report on a separate line for each class of securities beneficially (Page 2) owned directly or indirectly. (Print or type responses) SEC 1474 (8/92)
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