0000943034-21-000021.txt : 20210617 0000943034-21-000021.hdr.sgml : 20210617 20210617162207 ACCESSION NUMBER: 0000943034-21-000021 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210615 FILED AS OF DATE: 20210617 DATE AS OF CHANGE: 20210617 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: 211025032 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 2021-06-15 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 2021-06-15 4 A 0 552 0 A 1552 D /s/ Taylor W. Watters, Attorney-in-fact for Brian J. VanDerBosch 2021-06-17