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*
Wells, John R. |
2. Issuer Name
and Ticker or Trading Symbol
Interface, Inc. (IFSIA) |
6. Relationship of Reporting Person(s) to
Issuer Senior Vice President | ||||||||
(Last) (First) (Middle)
2859 Paces Ferry Road, Suite 2000 |
3.
I.R.S.
Identification Number of Reporting Person, if an entity (voluntary) |
4.
Statement for Month/Day/Year January 31, 2003 | ||||||||
(Street)
Atlanta, GA 30339 |
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) |
Price | ||||||
Class B Common Stock |
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|
|
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|
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Class B Common Stock |
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By 401(k) | |||||||
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. 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)
|
||||
Code |
V |
(A) |
(D) |
Date |
Expiration |
Title |
Amount or Number of Shares | ||||||||
Employee Stock Option (right to buy |
$2.71 | 1/31/03 | A | 30,000 | 1/31/03(2) | 1/31/06 | Class A or Class B Common Stock |
30,000 | 0 | 30,000 | D | ||||
Explanation of
Responses:
(1) A substantial number of such shares are restricted shares subject to a risk of forfeiture under certain circumstances. (2) 50% of the option is exercisable as of the grant date, and the remaining 50% of the option vests and becomes exercisable on the first anniversary of the grant date. |
/s/ John R. Wells John R. Wells **Signature of Reporting Person |
2/04/03
|
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 |