-----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, USIrPOxlz7dAOd8+YXrGe7iFs/oz1sV6V5NOawayfyY4bTaEBACsWP59wyRoiJb5 RXDUSO8VJojx8TA/W82k8w== /in/edgar/work/20000817/0000897101-00-000847/0000897101-00-000847.txt : 20000922 0000897101-00-000847.hdr.sgml : 20000922 ACCESSION NUMBER: 0000897101-00-000847 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20000714 FILED AS OF DATE: 20000817 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: INSIGNIA SYSTEMS INC/MN CENTRAL INDEX KEY: 0000875355 STANDARD INDUSTRIAL CLASSIFICATION: [5040 ] IRS NUMBER: 411656308 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 001-13471 FILM NUMBER: 705084 BUSINESS ADDRESS: STREET 1: 10801 RED CIRCLE DR CITY: MINNETONKA STATE: MN ZIP: 55343 BUSINESS PHONE: 6129308200 MAIL ADDRESS: STREET 1: 10801 RED CIRCLE DRIVE STREET 2: 10801 RED CIRCLE DRIVE CITY: MINNETONKA STATE: MN ZIP: 55343 COMPANY DATA: COMPANY CONFORMED NAME: RAMSDELL W ROBERT CENTRAL INDEX KEY: 0000897480 STANDARD INDUSTRIAL CLASSIFICATION: [ ]DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 474 PASEO MIRAMAR CITY: PACIFIC PALISADES STATE: CA ZIP: 90272 BUSINESS PHONE: 3104595617 MAIL ADDRESS: STREET 1: 474 PASEO MIRAMAR CITY: PACIFIC PALASADES STATE: CA ZIP: 90272 4 1 0001.txt FORM 4 [ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instructions 1(b). 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 _______________________________________________________________________________ 1. Name and Address of Reporting Person RAMSDELL, W. ROBERT - ----------------------------------------------------- (Last) (First) (Middle) 474 PASEO MIRAMAR - ----------------------------------------------------- (Street) PACIFIC PALISADES, CA 90272 - ----------------------------------------------------- (City) (State) (Zip) _______________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol INSIGNIA SYSTEMS, INC. (ISIG) _______________________________________________________________________________ 3. IRS or Social Security Number of Reporting Person (Voluntary) _______________________________________________________________________________ 4. Statement for Month/Year AUGUST 2000 _______________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) _______________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] 10% Owner [X] Director [ ] Officer (give title below) [ ] Other (specify below) 7. Individual or Joint Group Filing (check applicable line) [X] Form filed by one reporting person [ ] Form Filed by more than one reporting person _______________________________________________________________________________ TABLE I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned - ------------------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. - --------------------- -------- ---------- ------------------------------ ----------- ---------- ---------- Amount of Owner- Securities ship Trans- Trans- Securities Acquired (A) Beneficially Form: action action or Disposed of (D) Owned at Direct Nature of Date Code (Instr. 3, 4 and 5) End of (D) or Indirect Title of (Month/ (Instr. 8) ---------------------------- Month Indirect Beneficial Security Day/ ---------- Amount (A) or Price (Instr. (I) Ownership (Instr. 3) Year) Code V (D) 3 and 4) (Instr. 4) (Instr. 4) - --------------------- -------- ---- ---- ----------- ------ --------- ----------- ---------- ---------- COMMON STOCK 7/14/00 M 90,000 A $1.25 D COMMON STOCK 8/15/00 P 5,000 A $5.3275 D COMMON STOCK 8/16/00 P 10,000 A $5.8175 915,567 D
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. *If the form is filed by more than one reporting person, see Instruction 4(b)(v). Page 2 FORM 4 (continued) TABLE II--Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g. puts, calls, warrants, options, convertible securities) - ------------------------------------------------------------------------------------------------------------------------------ 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. - ---------- -------- -------- -------- ---------- ------------ -------------- ------ ---------- --------- ---------- Title and Ownership Number of Date Exer- Amount of Form of Derivative cisable and Underlying Number of Deriv- Securities Expiration Securities Price Derivative ative Conver- Trans- Acquired (A) Date (Month/ (Instr. 3 of Securities Security: sion or Trans- action or Disposed Day/Year) and 4) Deriv- Benefi- Direct Exercise action Code of (D) -------------- -------------- ative cially (D) or Nature of Title of Price of Date (Instr. (Instr. 3, Date Amount Secur- Owned at Indirect Indirect Derivative Deriv- (Month/ 8) 4 and 5) Exer- Expir- or Num- ity End of (I) Beneficial Security ative Day/ -------- ---------- cis- ation ber of (Instr. Month (Instr. Ownership (Instr. 3) Security Year) Code V (A) (D) able Date Title Shares 5) (Instr. 4) 4) (Instr. 4) - ---------- -------- -------- ---- --- ---- ---- ------- ----- ----- ------ ------ ---------- -------- ---------- WARRANTS $1.25 7/14/00 M 90,000 IMMED. 6/24/01 C.S. 90,000 1.25 190,000 D
Explanation of Responses: - ----------------------------------------------------- - ----------------------------------------------------- /s/ W. ROBERT RAMSDELL August 16, 2000 ---------------------------------------- -------------------- ** 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 provided is insufficient, see Instruction 6 for procedure.
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