4 1 doc1.htm Form 4
Form 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 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(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person*
Liccardo, Michael A.
2. Issuer Name and Ticker or Trading Symbol
Amnis Systems Inc.   (AMNM)

6. Relationship of Reporting Person(s) to Issuer

(Check all applicable)      

_X_ Director                            _X_ 10% Owner
_X_ Officer (give title below)   ___ Other (specify below)

Chairman, President and Chief Executive Officer
(Last)             (First)            (Middle)

13252 Simon Lane
3. I.R.S. Identification Number of Reporting Person, if an entity
(voluntary)

4. Statement for Month/Day/Year

12/30/2002
(Street)

Los Altos Hills, CA 94022
5. If Amendment, Date of Original (Month/Day/Year)

 
7. Individual or Joint/Group Filing
(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
(City)             (State)             (Zip) 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)
4. Securities Acquired (A)
or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities
Beneficially Owned
Following Reported
Transactions
(Instr. 3 and 4)
6. Ownership Form:
Direct (D)
or Indirect (I)
(Instr. 4)
7. Nature of Indirect
Beneficial Ownership
(Instr. 4)
Code V Amount (A)
or
(D)
Price
Common Stock 12/30/2002 12/30/2002 A   12,500,000 A (1) 93,174,746 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 Instructions 4(b)(v).
 
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(Over)
SEC 1474 (9-02)
FORM 4 (continued)
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)
5.
Number of Derivative
Securities
Acquired (A) or Disposed of (D)
(Instr.3,4
and 5)
6.
Date Exercisable
and Expiration Date
(Month/Day/Year)
7.
Title and Amount of
Underlying Securities
(Instr. 3 and 4)
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
Security:
Direct (D) or Indirect (I)
(Instr. 4)
11.
Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
Code V (A) (D) Date
Exercisable
Expiration
Date
Title Amount
or
Number
of Shares
10% Convertible Debenture Due 2003 0.04 12/30/2002 12/30/2002 C     $500,000   (2) 01/14/2003 Common Stock 12,500,000     D  
10% Convertible Debenture Due 2005 (3) 01/14/2003 01/14/2003 A   $1,112,763     (2) 01/14/2005 Common Stock $1,112,763 (3) 47,758,069 D  
Explanation of Responses:

(1) The reporting person converted $500,000 of his 10% convertible debenture due 2003 on December 30, 2002 at the conversion price of $0.04 per share, resulting in his acquisition of 12,500,000 shares of common stock. The 10% convertible debenture due 2003 was convertible into common stock at a conversion price equal to $0.35, subject to adjustment to a lower conversion price through January 14, 2003.
(2) Immediately.
(3) The lower of (i) $0.35 or (ii) 70% of the average of the lowest three intraday prices during the 20 trading days immediately preceding conversion, subject to adjustment.


** Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
/s/ Michael A. Liccardo
**Signature of Reporting Person
Michael A. Liccardo
02/04/2003 
Date
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