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Form 4 |
UNITED STATES SECURITIES AND
EXCHANGE COMMISSION STATEMENT OF CHANGES IN
BENEFICIAL OWNERSHIP |
OMB APPROVAL | |
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OMB Number: 3235-0287 | |||
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Expires: January 31, 2005 | |||
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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*
Mitchell Goodman |
2. Issuer Name
and Ticker or Trading Symbol
National Vision, Inc. (NVI) |
6. Relationship of Reporting Person(s) to
Issuer Sr. Vice President, General Counsel and Secretary | ||||||||
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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 04/01/03 | ||||||||
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(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 | ||||||||
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(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 Stock* |
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1,000.00 |
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1,147.000 |
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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)
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Code |
V |
(A) |
(D) |
Date |
Expiration |
Title |
Amount or Number of Shares | ||||||||
| Explanation of
Responses: *Issuance of shares under Performance Share Award Agreement. |
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**Signature of Reporting Person |
04/02/03
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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). |
| ** | 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 |