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OMB APPROVAL |
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OMB Number: 3235-0287 Expires: January 31, 2005 Estimated average burden hours per response..................................0.5 |
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FORM 4 |
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 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 of Section 30(f) of the Investment Company Act of
1940
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1. Name and address of Reporting Person* KEANE KEVIN T.
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2. Issuer Name and Ticker or Trading Symbol MOD-PAC. (MPAC) |
6. Relationship of Reporting Person to
Issuer Chairman |
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(Last) (First) (Middle) 1801 Elmwood Avenue |
3. I.R.S.
Identification |
4. Statement for Month/Day/Year May 1, 2003 |
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(Street) Buffalo, NY 14207 |
5. If Amendment, Date of Original (Month/Day/Year) |
7. Individual
or Joint/Group Filing (Check applicable box) [X ] Form filed by One Reporting Person [ ] Form filed by More than One Reporting person |
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(City) (State) (Zip)
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Table 1 - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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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 |
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) |
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| $01 Par Value Common Stock | 4/30/03 | P |
500 Shares |
$5.10 | 133,545 |
D |
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| $01 Par Value Class B Stock |
243,236 |
D |
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| $01 Par Value Common Stock | 29,439 |
1 |
By Spouse | |||||||
| $01 Par Value Class B Stock |
12,414 |
1 |
By Spouse | |||||||
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 Instruction
4(b)(v).
Potential Persons who respond to the collection of information contained in this
form are not required to respond unless the form displays a currently valid OMB
control number.
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.Conver-sion or Exercise Price of Deri- vative Security |
3.Trans-action Date (Month/ Day/ Year) |
3A. Deemed Execution Date, if any (Month/ Day/ Year) |
4.Trans-action Code (Instr.8) |
5. Number of Derivative Securities Ac- quired (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 Deriv- ative Secur- ity (Instr. 5)
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9.Number of deriv- Secur- ities Bene- ficially Owned Follow- ing Reported Trans- action(s) (Instr. 4) |
10.Owner-ship Form of Deriv- ative Security Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code |
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(A) |
(D) |
Date Exer- cisable |
Expira- tion Date |
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Amount or Number of Shares |
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Explanation of Responses:
*Mr. Keane disclaims any beneficial interest in the shares held by his wife.
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** Intentional misstatements or
omissions of facts constitute Federal Criminal Violations |
/s/ C. Anthony Rider, as Power of Attorney
for |
May 1, 2003 |
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Signature of Reporting Person |
Date |
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C. Anthony Rider, as Power of Attorney for
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| Note: File three copies of
this Form, one of which must be manually signed. If space provided is
insufficient, see Instruction 6 for procedure. |
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Potential Persons who respond to the collection of information contained in this
form are not required to respond unless the form displays a currently valid OMB
control number.