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Gross Paul L – ‘4’ for 8/31/02 re: National Vision Inc.

On:  Thursday, 9/5/02, at 2:04pm ET   ·   For:  8/31/02   ·   Accession #:  868263-2-20   ·   File #:  1-16635

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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.

Statement of Changes in Beneficial Ownership of Securities by an Insider   —   Form 4   —   SEA’34
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 4           Form 4 for Paul L. Gross 08-22-2002                 HTML     21K 


This is an HTML Document rendered as filed.  [ Alternative Formats ]



  Form 4  
 <>   <> 

Form 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, DC 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 or Section 30(h) of the Investment Company Act of 1940

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
hours per response. . . 0.5

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
(Check all applicable)
___ Director                    ___ 10% Owner
  X   Officer (give             ___ Other (specify
                  title below)                     below)

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)

Lawrenceville, GA  30045

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


08/22/02



A


V


9,000


A


$1.00

9,000


D



 









 









 








 


 

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. 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. 
Title and
Amount of
Underlying
Securities
(Instr. 3
and 4)

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
Exercisable

Expiration
Date

Title

Amount
or
Number
of Shares
































































Explanation of Responses:

_____________________________
_____________________________
_____________________________

  /s/ Mitchell Goodman


Mitchell Goodman for Paul L. Gross

**Signature of Reporting Person

 09/04/02 


Date
  
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

Dates Referenced Herein

This ‘4’ Filing    Date    Other Filings
1/31/05None on these Dates
Filed on:9/5/02
For Period end:8/31/02
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Filing Submission 0000868263-02-000020   –   Alternative Formats (Word / Rich Text, HTML, Plain Text, et al.)

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