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FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB APPROVAL
------ WASHINGTON, D.C. 20549 --------------------------------
OMB Number: 3235-0287
[ ] Check this box if no longer STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Expires: January 31, 2005
subject to Section 16. Form 4 Estimated average burden
or Form 5 obligations may hours per response..........0.5
continue. See Instruction 1(b) --------------------------------
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 or Section 30(h) of the Investment Company Act of 1940
(Print or Type Responses)
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1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting
Person to Issuer
(Check all applicable)
Dick Robert H. VLFG-Valley Forge Scientific Corp.
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(Last) (First) (Middle) 3. IRS Identifi- 4. Statement for Month/Day/Year [X] Director [ ] 10% Owner
cation Number [ ] Officer [ ] Other
of Reporting (give title (specify below)
Person, if an below)
entity
(voluntary)
358 Hibiscus Avenue March 2003
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(Street) 5. If Amendment, Date of 7. Individual or Joint/Group Filing
Original (Month/Day/Year) (check applicable line)
[X] Form Filed by One Reporting Person
[ ] Form Filed by More than One
Palm Beach FL 33480 Reporting Person
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(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1. Title 2. Trans- 2A.Deemed 3.Trans- 4. Securities Acquired (A) 5. Amount of 6. Ownership Form: 7. Nature of
of action Execution action or Disposed of (D) Securities Direct (D) or Indirect
Security Date Date,if Code (Instr. 3,4 and 5) Beneficially Indirect (I) Beneficial
(Instr.3) any (Instr.8) Owned Following (Instr. 4) Ownership
(Month/Day/ Reported (Instr. 4)
(Month/ Year) Transaction(s)
Day/Year) (Instr. 3 and 4)
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Code V Amount (A) or (D) Price
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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. (Over)
FORM 4 (continued)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(E.G., puts, calls, warrants, options, convertible securities)
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1. Title of 2. Conversion 3. Transaction 3A.Deemed 4. Transaction 5. Number of
Derivative or Exercise Date Execution Code Derivative
Security Price of (Month/Day/ Date, if (Instr. 8) Securities
(Instr. 3) Derivative Year) any Acquired (A)
Security (Mo/Dy/Yr) or Disposed
of (D)
(Instr. 3, 4,
and 5)
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Code V (A) (D)
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Stock Option $1.06 3/13/03 A V 10,000
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FORM 4 (continued)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(E.G., puts, calls, warrants, options, convertible securities)
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6. Date 7. Title and Amount 8. Price of 9. Number of 10. Ownership 11. Nature of
Exercisable of Underlying Derivative Derivative Form of Indirect
and Expiration Securities Security Securities Derivative Beneficial
Date (Instr. 3 and 4) Beneficially Security: Ownership
(Month/Day/Year) (Instr. 5) Owned Follow- Direct (D) or (Instr. 4)
ing Reported Indirect (I)
Transactions(s) (Instr. 4)
(Instr. 4)
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Amount
Date Expir- or
Exer- ation Number
cisable Date Title of Shares
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3/13/03 2/13/13 Common 10,000 44,000 D
Stock
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Explanation of Responses:
/s/ ROBERT H. DICK March 14, 2003
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**Signature of Reporting Person Date
** Intentional misstatements or omissions of facts constitute Federal Criminal
Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed.
If space provided is insufficient, see Instruction 6 for procedure.