0000897101-12-000830.txt : 20120522 0000897101-12-000830.hdr.sgml : 20120522 20120522165759 ACCESSION NUMBER: 0000897101-12-000830 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120518 FILED AS OF DATE: 20120522 DATE AS OF CHANGE: 20120522 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BRACKE JAMES W CENTRAL INDEX KEY: 0001265843 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-26056 FILM NUMBER: 12862164 MAIL ADDRESS: STREET 1: 15411 MASON POINTE CITY: EDEN PRAIRIE STATE: MN ZIP: 55347 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: IMAGE SENSING SYSTEMS INC CENTRAL INDEX KEY: 0000943034 STANDARD INDUSTRIAL CLASSIFICATION: MEASURING & CONTROLLING DEVICES, NEC [3829] IRS NUMBER: 411519168 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 500 SPRUCE TREE CENTRE STREET 2: 1600 UNIVERSITY AVE CITY: ST PAUL STATE: MN ZIP: 55104-3825 BUSINESS PHONE: 6516037700 MAIL ADDRESS: STREET 1: 500 SPRUCE TREE CENTRE STREET 2: 1600 UNIVERSITY AVE W. CITY: ST PAUL STATE: MN ZIP: 55104 4 1 image122251bracke_4.xml FORM 4 X0305 4 2012-05-18 0 0000943034 IMAGE SENSING SYSTEMS INC ISNS 0001265843 BRACKE JAMES W 1600 UNIVERSITY AVE W #500 ST PAUL MN 55104 1 0 0 0 Common Stock 2012-05-18 4 P 0 951 6.00 A 1951 D Non-qualified Stock Option (Right to Buy) 6.12 2012-05-18 4 A 0 4000 0 A 2016-05-18 Common Stock 4000 4000 D The option vests on April 18, 2013. /s/ Gregory R. L. Smith, Attorney-in-Fact for James W. Bracke 2012-05-22