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FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP |
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1. Name and Address of Reporting
Person*
Gross Paul L. |
2. Issuer Name and Ticker
or Trading Symbol
National Vision, Inc. (NVI) |
6. Relationship of Reporting Person(s) to Issuer Senior Vice President | ||||||||
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(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 11/15/02 | ||||||||
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(Street) Lawrenceville, GA 30045 |
5. If Amendment, Date of Original (Month/Day/Year)
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7. Individual or Joint/Group Filing (Check Applicable Line) X Form filed by One Reporting Person ___ Form filed by More than One 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 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) |
Price | ||||||
Common |
11/15/2002 |
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3,000 |
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3,000 |
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FORM 4 (continued) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned |
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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 |
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)
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Code |
V |
(A) |
(D) |
Date |
Expiration |
Title |
Amount or Number of Shares |
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| Employee Stock Option-- Right to Buy |
$1.00 |
08/22/02 |
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9,000 |
(1) |
08/22/12 |
Common |
9,000 |
9,000 |
D |
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| Explanation of
Responses: _____________________________ _____________________________ _____________________________ |
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/s/ Mitchell Goodman Mitchell Goodman for Paul L. Gross **Signature of Reporting Person |
11/18/02 |
| 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 |