OMB APPROVAL |
OMB Number: 3235-0287 |
Expires: January 31, 2005 |
Estimated average burden hours per response...0.5 |
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). |
| ||||||||||||
1. | Name and Address of Reporting Person* Stofer Gordon 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) | |||||||
|
|
| ||||||||||
(Last) (First) (Middle) Cherry Tree Investment, Inc. 301 Carlson Parkway, Suite 103 |
4. | Statement for Month/Day/Year 02/21/2003 |
5. | If Amendment, Date of Original (Month/Year) | ||||||||
|
|
| ||||||||||
(Street) Minnetonka MN 55305 |
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 | ||||||
o | 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 | 02/21/2003 | M | 3,162 | A | $1.75 | 4,976 | 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) | ||
| |||||||||||||
Non-Qualified Stock Option | $1.750 | 02/21/2003 | M | 5,000 | |||||||||
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) | ||
| |||||||||||||
05/21/1998 | 05/21/2003 | CS | 5,000 | 20,000 | D | ||||||||
|
Explanation of Responses:
Payment of exercise price by withholding of shares pursuant to exempt plan.
/s/ Gordon F. Stofer | 02/25/2003 | |
**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