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UNITED STATES FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934, |
o | Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
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1. | Name and Address of Reporting Person* Drill Scott F |
2. | Issuer Name and Ticker or Trading Symbol Insignia Systems, Inc. (ISIG) |
3. | I.R.S. Identification Number of Reporting Person, if an entity (voluntary) | |||||||
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(Last) (First) (Middle) |
4. | Statement for Month/Day/Year February 20, 2003 |
5. | If Amendment, Date of Original (Month/Year) | ||||||||
6470 Sycamore Court North
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(Street) |
6. | Relationship of Reporting Person(s) to Issuer (Check All Applicable) |
7. | Individual or Joint/Group Filing (Check One) | ||||||||
Maple Grove MN 55369
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) |
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President and CEO
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* | If the form is filed by more than one reporting person, see instruction 4(b)(v). |
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Table I Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||||||||||||||||
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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) | |||||||||
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Common Stock | 2/20/03 | M | 201,391 | A | $1.063 | |||||||||||||||||||
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Common Stock | 2/20/03 | S | 106,000 | D | $4.75 | 297,570 | D | |||||||||||||||||
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
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Table II Derivative
Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||
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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) | ||
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Non-Qualified Stock Option | $1.063 | 2/20/03 | M | 40,000 | |||||||||
Non-Qualified Stock Option | $1.063 | 2/20/03 | M | 30,000 | |||||||||
Non-Qualified Stock Option | $1.063 | 2/20/03 | M | 36,000 | |||||||||
Incentive Stock Option | $1.063 | 2/20/03 | M | 60,000 | |||||||||
Incentive Stock Option | $1.063 | 2/20/03 | M | 35,391 | |||||||||
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Table II Derivative
Securities Acquired, Disposed of, or Beneficially Owned
Continued (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||
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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) | ||
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8/24/98 | 2/24/03 | CS | 40,000 | ||||||||||
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9/24/98 | 2/24/03 | CS | 30,000 | ||||||||||
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2/24/01 | 2/24/03 | CS | 36,000 | ||||||||||
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8/24/98 | 2/24/03 | CS | 30,000 | ||||||||||
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2/24/01 | 2/24/03 | CS | 35,391 | 125,000 | D | ||||||||
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Explanation of Responses:
/s/ Scott Drill | 2/21/03 | |
**Signature of Reporting Person |
Date |
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** | 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. | |
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