0000943034-21-000014.txt : 20210609 0000943034-21-000014.hdr.sgml : 20210609 20210609164310 ACCESSION NUMBER: 0000943034-21-000014 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210609 FILED AS OF DATE: 20210609 DATE AS OF CHANGE: 20210609 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: VANDERBOSCH BRIAN CENTRAL INDEX KEY: 0001861103 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35959 FILM NUMBER: 211005572 MAIL ADDRESS: STREET 1: 1600 UNIVERSITY AVE W STREET 2: SUITE 400 CITY: SAINT PAUL STATE: MN ZIP: 55104 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: 400 SPRUCE TREE CENTRE STREET 2: 1600 UNIVERSITY AVE CITY: ST PAUL STATE: MN ZIP: 55104-3825 BUSINESS PHONE: 6516037700 MAIL ADDRESS: STREET 1: 400 SPRUCE TREE CENTRE STREET 2: 1600 UNIVERSITY AVE W. CITY: ST PAUL STATE: MN ZIP: 55104 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2021-06-09 0 0000943034 IMAGE SENSING SYSTEMS INC isns 0001861103 VANDERBOSCH BRIAN 1600 UNIVERSITY AVE W SUITE 400 SAINT PAUL MN 55104 1 0 0 0 Common Stock 2021-06-09 4 P 0 1000 7.2 A 1000 D /s/ Taylor W. Watters, Attorney-in-fact for Brian J. VanDerBosch 2021-06-09