-----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, FBD/I5o3eV08zl0YqvDbMILM81hvHp8FWcfDIG8Fi2XbczzakhI8JnVcx51T6qpI n+BvmkLIhES65HePFZe2lA== 0000897101-02-000902.txt : 20021220 0000897101-02-000902.hdr.sgml : 20021220 20021220172013 ACCESSION NUMBER: 0000897101-02-000902 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021220 FILED AS OF DATE: 20021220 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INSIGNIA SYSTEMS INC/MN CENTRAL INDEX KEY: 0000875355 STANDARD INDUSTRIAL CLASSIFICATION: WHOLESALE-PROFESSIONAL & COMMERCIAL EQUIPMENT & SUPPLIES [5040] IRS NUMBER: 411656308 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13471 FILM NUMBER: 02865704 BUSINESS ADDRESS: STREET 1: 5025 CHESHIRE LANE NORTH CITY: PLYMOUTH STATE: MN ZIP: 55446 BUSINESS PHONE: 7633926200 MAIL ADDRESS: STREET 1: 5025 CHESHIRE LANE NORTH CITY: PLYMOUTH STATE: MN ZIP: 55346 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: DRILL SCOTT CENTRAL INDEX KEY: 0001122091 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 5025 CHESHIRE LN NORTH CITY: PLYMOUTH STATE: MN ZIP: 55446 BUSINESS PHONE: 7633926203 MAIL ADDRESS: STREET 1: 5025 CHESHIRE LN NORTH CITY: PLYMOUTH STATE: MN ZIP: 55446 4 1 isig-drill026103_4.htm ISIG/DRILL FORM 4
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549

FORM 4

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(h) of the Investment Company Act of 1940

o Check this box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).

1. Name and Address of Reporting
Person*

   Drill           Scott           F
2. Issuer Name and Ticker or
Trading Symbol

3. I.R.S. Identification Number of Reporting
Person, if an entity (voluntary)

   
   
 
    (Last)       (First)       (Middle)

5025 Cheshire Lane North
4. Statement for Month/Day/Year

12/20/2002
5. If Amendment, Date of Original (Month/Year)

   
   
 
  (Street)

Plymouth                MN              55446
6. Relationship of Reporting Person(s)
to Issuer (Check All Applicable)
7. Individual or Joint/Group Filing
(Check One)
   
(City)                (State)           (Zip)
  x  Director o  10% Owner   x Form filed by One Reporting Person
    x  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)

 
       
     

*   If the form is filed by more than one reporting person, see instruction 4(b)(v).

 

 


Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1. Title of Security
(Instr. 3)
2. Transaction Date
(Month/Day/Year)
2a. Deemed Execution
Date, if any.
(Month/Day/Year)
3. Transaction Code
(Instr. 8)


Code      ¦       V
4. Securities Acquired (A)
or Disposed of (D)
(Instr. 3, 4 and 5)
                  (A)
Amount   ¦   or    ¦    Price
                  (D)
5. Amount of Securities
Beneficially Owned
Following Reported
Transactions(s)
(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)
(Instr. 4)
7. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)

   Common Stock   12/20/2002   G   1,000 D      26,836     D  


Reminder:  Report on a separate line for each class of securities beneficially owned directly or indirectly.

Page 2

 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)

1. Title of Derivative
Security
(Instr. 3)
2. Conversion or Exercise
Price of Derivative
Security
3. Transaction
Date
(Month/Day/Year)
3a. Deemed Execution Date,
if any.
(Month/Day/Year)
4. Transaction
Code
(Instr. 8)

   Code       ¦        V
5. Number of Derivative Securities
Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)

   (A)        ¦        (D)

                            

Page 3

 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

6. Date Exercisable and
Expiration Date
(Month/Day/Year)

Date                Expiration
Exercisable   ¦   Date
7. Title and Amount
of Underlying Securities
(Instr. 3 and 4)
                  Amount or
                  Number of
Title     ¦     Shares
8. Price of Derivative
Security
(Instr. 5)
9. Number of Derivative
Securities Beneficially Owned
Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of
Derivative Securities
Beneficially Owned
at End of Month
11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)

             

Explanation of Responses:
 

/s/  Scott Drill   12/20/2002

**Signature of Reporting Person
 
Date
 

**   Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 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, see Instruction 6 for procedure.
 

Page 4

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