0000897101-12-000868.txt : 20120525 0000897101-12-000868.hdr.sgml : 20120525 20120525152345 ACCESSION NUMBER: 0000897101-12-000868 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120523 FILED AS OF DATE: 20120525 DATE AS OF CHANGE: 20120525 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DRILL SCOTT CENTRAL INDEX KEY: 0001122091 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-13471 FILM NUMBER: 12871126 MAIL ADDRESS: STREET 1: 5025 CHESHIRE LN NORTH CITY: PLYMOUTH STATE: MN ZIP: 55446 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: INSIGNIA SYSTEMS INC/MN CENTRAL INDEX KEY: 0000875355 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-ADVERTISING [7310] IRS NUMBER: 411656308 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 8799 BROOKLYN BLVD. CITY: MINNEAPOLIS STATE: MN ZIP: 55445 BUSINESS PHONE: 7633926200 MAIL ADDRESS: STREET 1: 8799 BROOKLYN BLVD. CITY: MINNEAPOLIS STATE: MN ZIP: 55445 4 1 isig122300drill_4.xml INSIGNIA SYSTEMS, INC. (DRILL) FORM 4 X0305 4 2012-05-23 0 0000875355 INSIGNIA SYSTEMS INC/MN ISIG 0001122091 DRILL SCOTT 8799 BROOKLYN BLVD MINNEAPOLIS MN 55445 1 1 0 0 Chairman and CEO Incentive Stock Option 1.74 2012-05-23 4 A 0 20000 1.74 A 2013-05-23 2022-05-23 Common Stock 20000 20000 D Exercisable in annual one-third increments on the first, second, and third anniversaries of the date of this option grant. /s/ Scott Drill 2012-05-25