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As Of Filer Filing For·On·As Docs:Size Issuer Filing Agent 9/05/02 Gross Paul L 4 Officer 1:20K National Vision Inc. National Vision Inc. |
Document/Exhibit Description Pages Size 1: 4 Form 4 for Paul L. Gross 08-22-2002 HTML 21K
Form 4 |
Form 4 |
UNITED STATES SECURITIES AND
EXCHANGE COMMISSION STATEMENT OF CHANGES IN
BENEFICIAL OWNERSHIP |
OMB APPROVAL | |
OMB Number: 3235-0287 | |||
Expires: January 31, 2005 | |||
[ ] |
Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See instructions 1(b). |
Estimated average burden |
1. Name
and Address of Reporting Person*
Paul L. Gross |
2. Issuer Name
and Ticker or Trading Symbol
National Vision, Inc. (NVI) |
6. Relationship of Reporting Person(s) to
Issuer Senior Vice President | ||||||||
(Last) (First) (Middle) 296 Grayson Highway |
3.
I.R.S.
Identification Number of Reporting Person, if an entity (voluntary) |
4.
Statement for Month/Day/Year 08/22/02 | ||||||||
(Street) |
5. If
Amendment, Date of Original (Month/Day/Year) |
7. Individual
or Joint/Group Filing (Check Applicable Line) X Form filed by One Reporting Person ___ Form filed by More than One Reporting Person | ||||||||
(City) (State) (Zip) |
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||
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 Disposed of (D) (Instr. 3, 4 and 5) |
5. Amount
of Securities Beneficially Owned Following Reported Transactions(s) (Instr. 3 and 4) |
6.
Ownership Form: Direct (D) or Indirect (I) (Instr. 4) |
7. Nature
of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common |
|
|
|
9,000 |
|
$1.00 |
9,000 |
|
| |
FORM 4 (continued) |
Table II - Derivative Securities Acquired,
Disposed of, or Beneficially Owned |
1. Title of Derivative Security (Instr.3) |
2.
Conversion or Exercise Price of Derivative Security |
3. Transaction Date (Month/Day Year) |
3A. Deemed Execution Date, if any (Month/Day/Year) |
4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Securities Beneficially Owned at End of Month (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4)
|
||||
Code |
V |
(A) |
(D) |
Date |
Expiration |
Title |
Amount or Number of Shares | ||||||||
Explanation of
Responses: _____________________________ _____________________________ _____________________________ |
/s/ Mitchell GoodmanMitchell Goodman for Paul L. Gross **Signature of Reporting Person |
09/04/02
| |
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). |
** | 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 is insufficient, see Instruction 6 for procedure |
This ‘4’ Filing | Date | Other Filings | ||
---|---|---|---|---|
1/31/05 | None on these Dates | |||
Filed on: | 9/5/02 | |||
For Period end: | 8/31/02 | |||
List all Filings |